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1.
BMJ Case Rep ; 14(9)2021 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-34518179

RESUMO

We present a case reporting a rare combination of base of fourth metacarpal fracture and coronal body of hamate fracture, treated conservatively with excellent results. High index of suspicion for undetected bony injuries drove the execution of a CT scan, which allowed us to make a full correct diagnosis and plan treatment. Moreover, this case becomes the first reported case in the literature of such injury causing the intrusion of the base of the fifth metacarpal within the hamate bone, thus causing the coronal pattern of the hamate fracture. Differently from the common surgical management of this type of injury, we successfully treated this patient with close reduction and immobilisation, with full recovery after 3 months.


Assuntos
Fraturas Ósseas , Hamato , Ossos Metacarpais , Fraturas Cranianas , Traumatismos do Punho , Adulto , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Hamato/diagnóstico por imagem , Hamato/cirurgia , Humanos , Masculino , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/cirurgia
2.
Curr Sports Med Rep ; 20(6): 312-318, 2021 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-34099609

RESUMO

ABSTRACT: Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.


Assuntos
Artralgia , Traumatismos em Atletas , Traumatismos dos Tendões , Ulna , Traumatismos do Punho/complicações , Artralgia/diagnóstico , Artralgia/etiologia , Artralgia/terapia , Atletas , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/terapia , Beisebol/lesões , Beisebol/fisiologia , Fenômenos Biomecânicos , Golfe/lesões , Golfe/fisiologia , Ginástica/lesões , Ginástica/fisiologia , Hamato/lesões , Hóquei/lesões , Hóquei/fisiologia , Humanos , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/terapia , Tênis/lesões , Tênis/fisiologia , Fibrocartilagem Triangular/lesões , Traumatismos do Punho/epidemiologia , Articulação do Punho/anatomia & histologia , Articulação do Punho/fisiologia
3.
Orthop Surg ; 13(5): 1596-1601, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34109731

RESUMO

OBJECTIVE: Complex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference. METHODS: In a prospective single-center study, we investigated the tilt angle of 60 normal hamates. The study included thin-layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3-Matics software for three-dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle ß between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface. RESULTS: The average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05). CONCLUSIONS: The horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.


Assuntos
Articulações Carpometacarpais/cirurgia , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Hamato/cirurgia , Amplitude de Movimento Articular , Adolescente , Adulto , Articulações Carpometacarpais/lesões , Feminino , Hamato/lesões , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto Jovem
4.
J Hand Surg Asian Pac Vol ; 26(2): 240-244, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33928855

RESUMO

Background: Hemi-hamate arthroplasty is one of the treatment options for dorsal proximal interphalangeal joint fracture dislocation. Many studies reported favorable outcomes. However, some long term studies demonstrated the degenerative change of PIP joint. The articular mismatch of the hemi-hamate autograft might play an important role of this complication. Methods: We studied the anatomy of distal articular surface of the hamate bone in embalmed hamate bones. The anatomy of distal articular surface and dimensions of the hamate bone were measured and recorded. Results: Seventy hamate bones were dissected out from embalmed cadavers and included in this study. The mean angle of the 4th metacarpal articulation was 85.54 degrees (SD = 3.53) and mean angle of the 5th metacarpal articulation was 95.51 degrees (SD = 3.57). The inter-articular ridge was approximately 5 degrees radial inclination. Conclusions: The inter-articular ridge of distal articular surface was approximately 5 degrees radial inclination. In order to minimize the graft mismatch, we recommend making the bone cut with the saw blade tilted to radial side 5 degrees to achieve better alignment of inter-articular ridge of the graft.


Assuntos
Hamato/anatomia & histologia , Idoso , Cadáver , Ossos do Carpo/anatomia & histologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Am J Sports Med ; 48(12): 3066-3071, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32833497

RESUMO

BACKGROUND: A fracture of the hook of the hamate is a common injury affecting professional baseball players. The treatment for these fractures ranges from nonoperative immobilization to excision of the fragment. PURPOSE/HYPOTHESIS: The purpose was to report the results of surgical treatment of hook of hamate fractures in professional baseball players and determine which factors are associated with return to sport (RTS) and time to RTS. The hypothesis was that there is a high rate of RTS in professional baseball players after surgical treatment of the hook of the hamate fracture with no significant decline in performance after RTS. STUDY DESIGN: Descriptive epidemiology study. METHODS: All professional baseball players who underwent excision of the hook of the hamate between 2010 and 2017 were included. Player characteristic and performance data (before and after surgery) were recorded. Performance metrics were then compared before and after surgery. RESULTS: Overall, 261 players were included. Of total injuries, 96% were due to hitting, 86% occurred on the nondominant hitting side, and 89% were acute fractures (11% were nonunion cases). Most (95%) injuries occurred at the Minor League level and 96.2% of procedures were performed by hand fellowship-trained surgeons. Eight percent of players underwent concomitant procedures. The average tourniquet time was 31 ± 13 minutes. In total, 81% of players returned to sport at the same or higher level; 3% returned to sport at a lower level. The median time to RTS after surgery was 48 days (range, 16-246 days). The tourniquet time and number of days to RTS were significantly associated with one another (P = .001; Spearman ρ = 0.290; N = 130). Player utilization significantly increased after surgery. While player efficiency, including batting average (BA), on-base percentage (OBP), and on-base plus slugging percentage (OPS), significantly decreased, these changes were numerically small (BA: 0.26 ± 0.04 preoperatively vs 0.25 ± 0.04 postoperatively; OBP: 0.34 ± 0.04 preoperatively vs 0.32 ± 0.04 postoperatively; OPS: 0.73 ± 0.12 preoperatively vs 0.70 ± 0.11 postoperatively) (P < .001). There were no significant differences between rates of RTS to the same or higher level of play among acute fractures (81%) and nonunion cases (76%) (P = .837). CONCLUSION: After surgical excision for hook of hamate fractures in professional baseball players, 84% were able to RTS, with 81% returning to the same or higher level. The median time for players to RTS after surgery was 48 days. Player usage increased after surgery, while hitting efficiency slightly declined.


Assuntos
Beisebol/lesões , Fraturas Ósseas , Hamato , Volta ao Esporte , Traumatismos do Punho/cirurgia , Atletas , Desempenho Atlético , Fraturas Ósseas/cirurgia , Hamato/cirurgia , Humanos
8.
JBJS Case Connect ; 10(2): e0361, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32649122

RESUMO

CASE: Coronal shear fractures of the hamate are relatively rare injuries. Surgical intervention is recommended for displaced fractures. However, there is no established surgical procedure for the displaced coronal shear fractures of the hamate. Therefore, we present 2 cases of the displaced coronal hamate fracture with metacarpal dislocations, which were successfully managed with open reduction and internal fixation, using the headless compression screw by the 2-directional approach. CONCLUSION: Our procedure ensured that the screw's distal end captured the hamate hook, and the displaced bone fragments were reduced considerably in both cases.


Assuntos
Articulações Carpometacarpais/lesões , Hamato/lesões , Fixadores Internos , Redução Aberta/métodos , Traumatismos do Punho/cirurgia , Adulto , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/cirurgia , Feminino , Hamato/diagnóstico por imagem , Humanos , Masculino , Redução Aberta/instrumentação , Reoperação , Traumatismos do Punho/diagnóstico por imagem
9.
Comput Math Methods Med ; 2020: 7582181, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32617118

RESUMO

In carpal tunnel volume measurements, the angle of the hamatum curvature is not considered a variable, and its effect on carpal tunnel volume has not been investigated. We hypothesize that a change in the anatomical angle of the hamatum curvature changes the carpal tunnel volume. To prove our hypothesis, we used a mathematical simulation model considering the carpal tunnel as a truncated cone. We reviewed the wrist CT scans of 91 adults (>18 years of age), including 51 men and 40 women. We measured the angle of the hamatum curvature in the CT scans. We measured cross-sectional areas at the outlet of the carpal tunnel at the level of the trapezium and hook of hamate (r1) and at the inlet at the level of the scaphoid and pisiform (r2) and the length (h) of the carpal tunnel. We attempted to calculate the effect of 2 degree by 2-degree changes in the angle of the hamatum curvature between the angles of 98° and 140° on the carpal tunnel volume. The mean angle of the hook of hamatum of the subjects was 122.55° ± 8.20° (range, 97.20° - 139.31°). No suitable cutoff point was found for the angle values. There was no difference between the gender groups according to the angle value. The data clearly show that there is a high correlation between carpal tunnel volume and the angle of hamatum curvature. The results of our study emphasize the importance of taking into account the anatomical features of the hamatum bone, especially the angle of curvature, which may play a predisposing role in idiopathic carpal tunnel syndrome.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/patologia , Hamato/anatomia & histologia , Hamato/diagnóstico por imagem , Modelos Anatômicos , Adulto , Ossos do Carpo/anatomia & histologia , Ossos do Carpo/diagnóstico por imagem , Biologia Computacional , Simulação por Computador , Feminino , Humanos , Imageamento Tridimensional , Masculino , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Ortop Traumatol Rehabil ; 22(2): 143-149, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32468994

RESUMO

Capitate and hamate fractures are infrequent injuries and are uncommon in isolation. A capitate fracture is usually associated with a scaphoid fracture. The primary mechanism of injury is a fall with the wrist in hyperextension. Other possible ways for capitate fractures are axial down trauma of the third metacarpal and direct trauma. Hamate fractures have a 2% incidence among carpal bone fractures, probably due to underreporting. They can occur on the hamate body or the hamulus or hook. Combined capitate and hamate fractures are uncommon and relevant studies, especially case reports, are scarce. We present a case report of a combined capitate and hamate fracture in a 44-year-old patient who suffered a direct trauma to the back of the hand during a fall. Following a clinical suspicion based on history and physical examination, radiographic and computed tomography (CT) studies were crucial for elucidating the case and proposed treatment, which involved ensuring absolute stability and performing an open reduction, using interfragmentary compression, with the Herbert bone screw implanted in each bone. After the surgical procedure, the patient wore a forearm plaster cast splint for four weeks. A satisfactory outcome was obtained in three months, with a complete range of motion and preserved force compared to the contralateral hand.


Assuntos
Parafusos Ósseos , Capitato/lesões , Capitato/cirurgia , Moldes Cirúrgicos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Hamato/lesões , Hamato/cirurgia , Adulto , Humanos , Masculino , Amplitude de Movimento Articular , Resultado do Tratamento
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(4): 489-492, 2020 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-32291986

RESUMO

Objective: To explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook. Methods: Five patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness. Results: All the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] ( t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] ( t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case. Conclusion: For the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Hamato/lesões , Adulto , Feminino , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
12.
BMC Musculoskelet Disord ; 21(1): 231, 2020 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-32284050

RESUMO

BACKGROUND: Osteochondroma is a benign tumor that occurs mainly at the metaphysis of long bones and seldom arises from carpal bones. We describe an extremely rare case of osteochondroma of the hamate without a typical cartilaginous cap and with a spiky bony protrusion in an elderly patient. CASE PRESENTATION: A 78-year-old right-handed female housekeeper had a multilobed osteochondroma of the hamate, which caused carpal tunnel syndrome and irritation of the flexor tendons. Radiological examinations showed a morphological abnormality of the hamate comprising a spiky bony protrusion into the carpal tunnel and a free body proximal to the pisiform. Open carpal tunnel release and resection of the spiky bony protrusion on the hook of the hamate were performed. The flexor digitorum profundus tendons of the ring and little fingers displayed synovitis and partial laceration in the carpal tunnel. Histological examination also showed atypical findings: only a few regions of cartilaginous tissue were seen in the spiky bony protrusion, whereas the free body proximal to the pisiform contained thick cartilaginous tissue such as a cartilaginous cap typical of osteochondroma. We speculated that the bony protrusion to the carpal tunnel had been eroded by mechanical irritation caused by gliding of the flexor tendon and had resulted in the protruding spiky shape with less cartilaginous tissue. The fractured cartilaginous cap had moved into the cavity within the carpal tunnel proximal to the pisiform and had become a large free body. CONCLUSIONS: Osteochondroma of the carpal bone may take various shapes because the carpal bone is surrounded by neighboring bones and tight ligaments, which can restrict tumor growth. This type of tumor is likely to present with various symptoms because of the close proximity of important structures including nerves, tendons, and joints. The diagnosis of osteochondroma of the carpal bone may be difficult because of its rarity and atypical radiological and histological findings, such as the lack of a round cartilaginous cap. We suggest that surgeons should have a detailed understanding of this condition and should make a definitive diagnosis based on the overall findings.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Hamato/patologia , Osteocondroma/patologia , Punho/patologia , Idoso , Síndrome do Túnel Carpal/cirurgia , Feminino , Humanos , Osteocondroma/cirurgia , Radiografia , Tendões/patologia
13.
Tech Hand Up Extrem Surg ; 24(4): 187-193, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32349098

RESUMO

Fractures of the hamate are relatively rare and there is a paucity of literature describing their natural history, indications for operative fixation, surgical techniques, and outcomes. Most authors recommend operative fixation of displaced intra-articular coronal hamate body fractures, and a dorsal approach with Kirschner wires has most commonly been recommended to achieve this. In this report, a 2-incision approach to the hamate is presented that facilitates rigid internal fixation of coronal hamate body fractures with a cannulated headless compression screw and minimizes the possibility of iatrogenic injury to critical branches of the ulnar nerve. The authors summarize a series of 2 patients with displaced, intra-articular coronal hamate body fractures of differing severity treated successfully with the proposed approach.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/métodos , Hamato/cirurgia , Fraturas Intra-Articulares/cirurgia , Redução Aberta/métodos , Adulto , Hamato/lesões , Humanos , Masculino , Pessoa de Meia-Idade
15.
J Hand Surg Asian Pac Vol ; 25(1): 67-75, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000604

RESUMO

Background: This study aimed to describe a novel surgical technique in which a bridge plate was used for the treatment of hamatometacarpal fracture-dislocations and to assess its radiologic and clinical outcomes. Methods: A retrospective review of 16 patients treated with the bridge plate technique for hamatometacarpal fracture-dislocations was performed between 2010 and 2015. Clinical and radiographic evaluations were performed at months 3, 6, and 12 postoperatively. Active wrist and metacarpophalangeal joint ranges of motion and Quick Disabilities of Arm, Shoulder, and Hand (DASH) scores were recorded for the injured hands. Grip strength data were collected for both the injured hands and the contralateral uninjured hands. Results: All patients included in our study were male (mean age 31 years). The average Quick DASH score was 24.3 ± 9.1 at 3 months, 12.3 ± 7.3 at 6 months, and 6.2 ± 6.6 at 12 months. All patients returned to their original jobs within 5 weeks of the procedure. Grip strength eventually recovered to 90% of that of the uninjured hand, and none of the patients complained of finger or wrist joint stiffness. Conclusions: The use of the bridge plate technique may be an effective alternative treatment for patients with comminuted hamatometacarpal fracture-dislocations.


Assuntos
Placas Ósseas , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Articulação da Mão/lesões , Adulto , Feminino , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/etiologia , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/etiologia , Hamato/lesões , Força da Mão , Humanos , Masculino , Ossos Metacarpais/lesões , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
J Hand Surg Am ; 45(7): 657.e1-657.e6, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31917048

RESUMO

PURPOSE: Dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint can lead to joint incongruity from loss of the buttress function of the middle phalanx volar base. Hemi-hamate arthroplasty can reconstruct the volar articular surface of the middle phalangeal base where repair is not possible. We compared the anatomy of the hamate graft with the middle phalanx base. METHODS: Forty unique skeletal specimens (40 hamates, 160 middle phalanges) were sampled. Anatomical features relevant to hemi-hamate reconstruction were measured, including the articular surface areas, the axial ridge angles, and the sagittal inclination angles of the hamate and the middle phalanx base specimens. Facets of the articular surfaces were classified as concave, convex, or flat. Calibrated measurements were made using digital photographs of the cadaveric specimens. Descriptive and univariate statistics were performed. RESULTS: There was greater variability in the distal hamate than in the middle phalanx base. The ring finger facet of the distal hamate was concave in 39 of 40 specimens, whereas the little finger facet was convex in 31 of 40 specimens. The hamate axial ridge angle (66.0° ± 3.7°) was significantly different from the middle phalanx base (90.4° ± 0.4°). The hamate articular sagittal inclination (3.2° ± 4.1°) was significantly different from the middle phalanx base (51.2° ± 1.3°). The hamate articular surface area (1.96 cm2) was significantly greater than the middle phalanx base (mean index/middle/ring finger = 0.85 cm2 and mean little finger = 0.59 cm2). CONCLUSIONS: The distal articular surface of the hamate is not anatomically identical to the middle phalanx base. The differences may still preclude anatomical reconstruction in the setting of a dorsal PIP fracture-dislocation, thereby affecting short- and long-term outcomes. CLINICAL RELEVANCE: Knowledge of the anatomical differences between the distal hamate and the middle phalanx base may improve graft harvest and inset during reconstruction.


Assuntos
Traumatismos dos Dedos , Falanges dos Dedos da Mão , Fratura-Luxação , Hamato , Luxações Articulares , Artroplastia , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Falanges dos Dedos da Mão/cirurgia , Hamato/diagnóstico por imagem , Hamato/cirurgia , Humanos , Luxações Articulares/cirurgia , Amplitude de Movimento Articular
17.
Curr Rheumatol Rev ; 16(3): 184-188, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30887926

RESUMO

Variation in lunate morphology can exist based on the absence (Type I) or presence (Type II) of medial facet on the distal articular surface of the lunate that contacts the proximal pole of the hamate. This additional lunatohamate articulation can affect load transmission across the radiocarpal joint and exert an influence on carpal kinematics. A Type II lunate is protective against carpal instability patterns associated with scaphoid nonunions and scapholunate dissociations. It may also play a role in the progression of carpal collapse that occurs in Kienböck disease. This review summarizes the effect of lunate morphology in the outcomes of non-operative and operative treatment of carpal disorders.


Assuntos
Variação Anatômica , Articulações do Carpo/fisiopatologia , Osso Semilunar/anatomia & histologia , Suporte de Carga/fisiologia , Traumatismos do Punho/fisiopatologia , Articulação do Punho/fisiopatologia , Fenômenos Biomecânicos , Articulações do Carpo/fisiologia , Hamato/fisiologia , Humanos , Osso Semilunar/fisiologia , Osteonecrose , Articulação do Punho/fisiologia
18.
Asian J Surg ; 43(6): 654-659, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31473048

RESUMO

BACKGROUND: Carpal tunnel syndrome is diagnosed based on history, physical examination, and nerve conduction testing; however, there are no clear criteria for the diagnosis of carpal tunnel syndrome. Recently, studies have aimed to diagnose carpal tunnel syndrome through ultrasound or MRI. The purpose of this study was to compare and analyze the cross-sectional area of the median nerve between patients with carpal tunnel syndrome and a control group. METHODS: From July 2015 to August 2017, we retrospectively analyzed fishery and white-collar workers (164 people, 37 men, 127 women). Carpal tunnel syndrome was diagnosed on the basis of both physical examination and nerve conduction testing. A negative result in either test led to exclusion from the study. RESULTS: In total, 164 wrist MRI were retrieved, with 67 patients diagnosed with carpal tunnel syndrome and 97 patients allocated to the control group. The mean value of cross-sectional area at the pisiform was 18.8 mm2 in the MRI of the carpal tunnel syndrome patients and 12.1 mm2 (p-value <0.05) in the control group. The mean value of cross-sectional area at the hook of hamate was 11.70 mm2 and that at the control group was 11.67 mm2 (p-value 0.055). CONCLUSION: Cross-sectional area at pisiform in MRI is a valuable factor in the diagnosis of carpal tunnel syndrome and in predicting the duration of pain.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Nervo Mediano/diagnóstico por imagem , Idoso , Síndrome do Túnel Carpal/complicações , Feminino , Hamato/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Condução Nervosa , Dor/etiologia , Exame Físico , Estudos Retrospectivos
19.
J Hand Surg Am ; 45(1): 69.e1-69.e7, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31300229

RESUMO

PURPOSE: To quantify the similarity of the surface topography of the proximal hamate and proximal pole of the scaphoid for nonunion reconstruction. METHODS: Using previously acquired computed tomographic scans of the wrist of 10 patients, the 2 bones were segmented and subsequently aligned using both a manual and automated technique. Surface error between corresponding articular surfaces was computed to determine the similarity of the shape of the 2 bones. RESULTS: The median distance between the 2 articulating surfaces for each patient was 1 mm or less for all cases. Maximum distance varied from 2.7 to 9.7 mm. The automated method improved alignment such that the maximum distance was 4.1 mm. Visual review of the alignment revealed that the maximum error occurred on or around the margin of the articulating surfaces. CONCLUSIONS: In most cases, the proximal hamate appears to be a suitable donor match to reconstruct proximal pole scaphoid nonunions. CLINICAL RELEVANCE: This study serves as a guide to practitioners when considering the suitability of the proximal hamate autograft for unsalvageable proximal pole scaphoid nonunions.


Assuntos
Fraturas não Consolidadas , Hamato , Osso Escafoide , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Hamato/diagnóstico por imagem , Hamato/cirurgia , Humanos , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Tomografia Computadorizada por Raios X , Articulação do Punho
20.
Hand (N Y) ; 15(3): 365-370, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-30124082

RESUMO

Background: Fractures of the hook of the hamate are rare. Nonoperative management has historically been immobilization in a short arm cast (SAC) without thumb immobilization with a high reported incidence of nonunion. The high prevalence of nonunion following nonoperative treatment may be secondary to motion at the fracture site. The transverse carpal ligament's attachment to the hook of the hamate results in movement at the fracture site during thumb motion. Methods: A cadaveric study using 8 fresh frozen cadaver arms amputated at the mid-humeral level was performed. Computed tomography (CT) imaging was used to assess the bony anatomy and assure no preexisting fractures were present. Osteotomy of the hook of the hamate was performed through a skin incision proximal to the hook of the hamate and the transverse carpal ligament. Each arm was then mounted in a jig designed to hold and stabilize the arm and hand in supination. CT scans were performed without cast immobilization with the thumb in extension and abduction, with SAC without thumb carpometacarpal joint immobilization, and SAC with thumb carpometacarpal joint immobilization. Results: Motion of the fractured hook of the hamate was found to occur in all noncasted specimens, greatest with base fractures. SAC without thumb immobilization had little to no effect in eliminating fracture motion. SAC including the thumb reduced fracture motion in all specimens. Conclusions: Previous poor experience with nonoperative management of fractures of the hook of the hamate may be partially due to inability to adequately immobilize the fracture fragment. Fracture motion of the hamate hook occurs during thumb movement, likely from traction on the fracture fragment by the transverse carpal ligament.


Assuntos
Ossos do Carpo , Fraturas Ósseas , Hamato , Cadáver , Fraturas Ósseas/cirurgia , Hamato/diagnóstico por imagem , Humanos , Polegar/cirurgia
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