A Comparison of the Outcomes of Excision of the Fractured Hook of Hamate via a Carpal Tunnel Approach versus a Lateral Approach.

Background: The excision of the hook of the hamate is an accepted modality for the treatment of hook of hamate fractures. Three surgical approaches to the hook of hamate have been described in literature. This includes two palmar approaches namely the Guyon canal approach and the carpal tunnel approach, and the lateral approach. The aim of this article is to compare the outcomes of the carpal tunnel approach and the lateral approach. Methods: Twenty-four patients with hook of hamate fractures were treated by excision of the hook of hamate. The hook of hamate was approached via the carpal tunnel in 15 patients and via the lateral approach in 9 patients. The outcomes with regard to duration of the surgery, complications such as pain, sensory disturbance and scar problems and time to return to sports were measured and analysed. Results: There were no significant differences in outcomes between the carpal tunnel and the lateral approach for excision of hook of hamate fractures. Conclusions: The outcomes of excision of the hook of hamate via the carpal tunnel approach and the lateral approach are similar. The decision to choose an approach should be based on the surgeon's familiarity with the approach. Future studies should include a comparison with the Guyon canal approach preferably in a homogenous group of patients. Level of Evidence: Level IV (Therapeutic).

Bilateral FCR Tendon Injury Associated with Osteoarthritis of the STT Joint.

Subcutaneous flexor carpi radialis (FCR) tendon ruptures secondary to osteoarthritis of the scapho-trapezio-trapezoidal (STT) joint are very rare. A 53-year-old female suffered a subcutaneous FCR tendon rupture after noticing pain in her right wrist. Because of continuing pain and decreasing strength in her right hand, surgery of the STT joint arthrodesis and an FCR tendon reconstruction with free tendon graft was performed. Her left wrist gradually showed the same symptoms 9 years later. The STT fusion for her left wrist was then performed. The FCR tendon was partially worn out on the spur of the trapezial ridge as well. Only 10 cases of FCR tendon ruptures have been reported due to definite STT osteoarthritis in six English papers. We believe STT fusion should be done without hesitation before tendon rupture occurs, and when motion pain around the STT joint and decreasing grip strength exists. However, it is controversial whether the FCR tendon reconstruction should be done in addition to STT fusion.