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1.
J Hand Surg Asian Pac Vol ; 27(1): 117-123, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35135422

RESUMO

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).


Assuntos
Síndrome do Túnel Carpal , Fraturas Ósseas , Hamato , Traumatismos do Punho , Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Hamato/diagnóstico por imagem , Hamato/lesões , Hamato/cirurgia , Humanos
2.
Hand Clin ; 37(4): 545-552, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34602134

RESUMO

Hook of hamate fractures are uncommon injuries with unclear prevalence. Classic presenting symptoms include volar-ulnar hand/wrist pain and weakness in grip, with possible ulnar nerve paresthesias. Patient factors, such as activity level and desired return to work/sport, shape the most appropriate treatment regimen although excision of the hook has been adopted by most surgeons. Overall, once patients receive the correct diagnosis and are treated, good outcomes with high satisfaction rates are expected.


Assuntos
Fraturas Ósseas , Hamato , Traumatismos da Mão , Traumatismos do Punho , Fraturas Ósseas/cirurgia , Hamato/diagnóstico por imagem , Hamato/cirurgia , Traumatismos da Mão/cirurgia , Humanos , Microcirurgia , Traumatismos do Punho/cirurgia
3.
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
4.
J Hand Surg Eur Vol ; 46(9): 941-945, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34256617

RESUMO

Many different surgical techniques have been used to treat unstable dorsal proximal interphalangeal joint fracture-dislocations. The authors have used the base of the middle phalanx of the second toe base as an alternative autograft to treat this type of injury. This retrospective study assessed the clinical outcomes of this procedure in 11 patients. Range of motion, grip strength, Disability of the Arm, Shoulder and Hand score and donor site morbidity were assessed at regular intervals postoperatively. Nine patients had acute injuries and two had chronic injuries. The mean range of motion in the proximal interphalangeal joint at final review was 65° for patients with acute injuries and 41° for patients with chronic injuries. Other outcomes were satisfactory and there were no complications.Level of evidence: IV.


Assuntos
Traumatismos dos Dedos , Hamato , Fraturas Intra-Articulares , Luxações Articulares , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Dedos do Pé
5.
Hand Surg Rehabil ; 40(6): 744-748, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34274497

RESUMO

Union of proximal pole scaphoid fracture is challenging because the vascular supply is limited. The avascular necrosis accompanying non-union and progressive fragmentation make surgical reconstruction difficult. The present study aimed to report short-term results of reconstruction with proximal hamate in proximal pole scaphoid non-union with avascular necrosis. Four patients (3 male, 1 female) were assessed for non-union following proximal pole scaphoid fracture. Mean age was 25.7 years (range, 22-35 years). Mean interval between injury and reconstruction was 7.5 years (range, 5-9 years). In 3 patients, no treatment was given following the fracture and in the other internal fixation was performed following cast immobilization. The non-united avascular proximal scaphoid was resected and reconstructed with proximal hamate autograft. Mean follow-up was 14.0 months (range, 9-22 months) after reconstruction. At the last control, cases were evaluated in terms of clinical and functional status, and radiologic union was determined on CT scan. Three patients reported subjective decrease in pain. Mean grip strength proportionally to the unaffected side was 24% (range, 8-51%), mean flexion-extension was 55.3% (range, 21-60%), and radial-ulnar deviation was 63.6% (range, 25-100%). Mean QuickDASH score was 32.3 (range, 13.6-52.2). Union was observed in all patients. Proximal hamate reconstruction provided union and pain relief, but only moderate objective functional results. It can be used as an alternative technique in proximal pole scaphoid non-union with avascular necrosis.


Assuntos
Fraturas Ósseas , Fraturas não Consolidadas , Hamato , Osteonecrose , Osso Escafoide , Adulto , Feminino , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Hamato/cirurgia , Humanos , Masculino , Osteonecrose/cirurgia , Osso Escafoide/lesões , Osso Escafoide/cirurgia
6.
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
7.
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
8.
JBJS Case Connect ; 11(2)2021 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-34111033

RESUMO

CASE: We performed computed tomography (CT)-assisted dorsal approach osteosynthesis for stress fractures of the hook of the hamate using the dorsal approach in 3 high school baseball players in the hybrid operating room. Bony union was observed in all patients on CT. All patients were able to play baseball without pain for at least 6 months after surgery. However, refractures were observed in all patients at a mean 9.7 months after surgery. CONCLUSION: The indications of osteosynthesis for stress fractures of the hook of the hamate in baseball players should be carefully considered.


Assuntos
Beisebol , Fraturas de Estresse , Hamato , Fixação Interna de Fraturas , Fraturas de Estresse/diagnóstico por imagem , Fraturas de Estresse/cirurgia , Hamato/diagnóstico por imagem , Hamato/cirurgia , Humanos , Tomografia Computadorizada por Raios X
9.
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
10.
Hand Surg Rehabil ; 40(4): 519-523, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33864940

RESUMO

Fractures of the hamate are rare, and a clear treatment algorithm does not exist. Nonetheless, surgical treatment is generally recommended for displaced fractures using a dorsal approach. There is also a lack of data on hamate malunion. We present a case of a 28-year-old female with a coronal malunion of the hamate and hamate hook fracture. Because the triquetrum prevented direct access to the fracture, we planned and undertook a transtriquetral coronal osteotomy based on three-dimensional computed tomography imaging data. After removing the bone callus, reduction was possible with subsequent fixation. We recommend performing a transtriquetral osteotomy to treat an otherwise inaccessible fracture or malunion of select hamate fractures.


Assuntos
Fraturas Ósseas , Hamato , Piramidal , Traumatismos do Punho , Adulto , Feminino , Fraturas Ósseas/cirurgia , Hamato/diagnóstico por imagem , Hamato/cirurgia , Humanos , Osteotomia , Traumatismos do Punho/cirurgia
13.
Hand (N Y) ; 16(4): 453-460, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-31517516

RESUMO

Background: Treatment of proximal interphalangeal joint (PIPJ) fracture-dislocations is difficult given the potential long-term complications of the involved finger and entire hand. Several surgical methods have been utilized for management of these injuries, none of which have shown consistently favorable results. The purpose of this systematic review of the literature is to report the post-operative outcomes of multiple treatment modalities for PIPJ fracture-dislocations in various studies. Methods: A literature review of PubMed and EMBASE databases was performed for all articles on PIPJ fracture-dislocations. Outcomes of interest included PIPJ range of motion, grip strength (% of contralateral hand), and quick disabilities of arm, shoulder, hand (QuickDASH). Articles were distributed into 5 groups by surgical method: open reduction, percutaneous fixation, dynamic external fixation, extension-block pinning, and hemi-hamate arthroplasty. Results: Forty-eight of 1679 total screened articles were included. The weighted means of post-operative range of motion (ROM; degrees) at final follow-up were open reduction 84.7 (n = 146), percutaneous fixation 86.5 (n = 32), dynamic external fixation 81.7 (n = 389), extension-block pinning 83.6 (n = 85), and hemi-hamate arthroplasty 79.3 (n = 52). Dorsal fracture-dislocations, regardless of surgical method, had an average ROM of 83.2 (n = 321), grip strength 91% (n = 132), and QuickDASH of 6.6 (n = 59) while pilon injuries had an average ROM of 80.2 (n = 48), grip strength 100% (n = 13), and QuickDASH of 11.4 (n = 13). Conclusion: Percutaneous fixation yielded the highest post-operative ROM at final follow-up while extension-block pinning resulted in the greatest grip strength. While dorsal fracture-dislocations produced higher average ROM and lower QuickDASH score, pilon fractures produced a higher grip strength. No treatment method or fracture type yielded consistently better outcomes than another.


Assuntos
Fraturas Ósseas , Hamato , Luxações Articulares , Articulações dos Dedos/cirurgia , Humanos , Luxações Articulares/cirurgia , Amplitude de Movimento Articular
14.
Eur J Trauma Emerg Surg ; 47(3): 825-829, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31811335

RESUMO

PURPOSE: Our aim was to investigate the clinical and radiological results of a hemi-hamate autograft arthroplasty method in patients with acute trauma who had a fragmented fracture of the proximal palmar joint surface of the middle phalanx and dorsal PIP subluxation. METHODS: A total of 13 fingers from 13 patients who met the criteria were included in the study (11 men and 2 women) and prospectively reviewed. The mean age of the patients was 39.5 years. The mean interval between the injury and surgery was 6.3 days. The active movement of the DIP, PIP, MP and wrist joints was started on postoperative day. Follow-ups were performed at 6 weeks, 3, 6 and 12 months postoperatively. Range of motion for the DIP, PIP and MP joints, DASH and VAS scores, grip strength, two-point discrimination, finger pulp and palmar curve distance were evaluated. RESULTS: All PIP joints were stable against coronal and sagittal stress at the 1st postoperative year and there was no limitation in wrist movements. Two-point discrimination was < 5 mm in all fingers. Union was achieved in all grafts except one. The mean active total PIP range of motion was 82.3°, DIP range of motion was 61.1°, MP joint motion was 87°. The mean DASH score was 7.6, and the mean VAS score was 1.5. The mean grip strength was 33.7 kg, which was 93% of the healthy side. The mean finger pulp and palmar curve distance was 8.6 mm. CONCLUSIONS: We believe that HHA is an appropriate alternative in cases of acute dorsal PIP fracture-dislocations with an intact middle phalanx dorsal cortex that is not suitable for primary fixation, with the advantages of obtaining stable joint and satisfactory functional results.


Assuntos
Traumatismos dos Dedos , Hamato , Fraturas Intra-Articulares , Luxações Articulares , Autoenxertos , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Humanos , Recém-Nascido , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Amplitude de Movimento Articular
15.
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
16.
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
17.
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
18.
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
19.
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
20.
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
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