Avascular Necrosis of the Hamate: Three Cases and Review of the Literature

Abstract

Background?Avascular necrosis of the hamate (hamate-AVN) is a seldom reported disease of which little is known on etiology, best treatment modalities, and outcome. Hamate-AVN can occur in multiple locations within the hamate. Case Description?Case one was an 8-year-old girl with painful AVN of the hamate hook. Surgical excision of the hook was performed, leading to excellent results (follow-up 8 years). Case two was a 44-year-old man with hamate-AVN of the proximal pole surgically treated with a vascularized bone graft from the radius based on the fifth extensor compartment artery, leading to excellent results (follow-up 7 years). Case three was a 36-year-old woman with hamate-AVN of the proximal pole surgically treated with d?bridement and cancellous bone grafting, leading to poor results (follow-up 1 year). Literature Review?Nine other cases of avascular necrosis of the hamate were found in literature, all but one treated surgically. Etiology, treatment, and results of these cases, combined with our own cases, are reviewed. Clinical Relevance?This article summarizes and synthesizes all presented cases of avascular necrosis of the hamate. We hope this will be helpful to physicians in decision making when confronted with this rare entity. Level of Evidence?4

Medial femoral condyle free flap for carpo-metacarpal instability following hamate comminute fracture

“…For this reason, we opted not to utilize external material, such as K-wires or surgical screws, in the first reconstructive stage to lower the risk of infection. In the literature, autogenous non-vascularised iliac crest bone grafts and vascularised radius bone grafts [ 6 ] were used for hamate complete reconstruction following oncological resection [ 7 ], avascular necrosis [ 8 – 12 ] and haematogenous osteomyelitis [ 17 ] but, in some reports, reconstruction was not considered necessary [ 8 , 10 , 13 – 16 ]. In this case, the instability of the 4th and 5th finger constrained to perform a vascularized arthrodesis for a successful outcome and avoiding complications derived from the hamate fracture and restoring an adequate carpal/metacarpal ratio.…”

Hook of the Hamate: The Spectrum of Often Missed Pathologic Findings

“…The clinical presentation is often nonspecific; patients present with nonlocalizing ulnar-sided wrist pain. Range of motion and grip strength are often variable [41]. Avascular necrosis is difficult to appreciate on radiographs and CT scans.…”

“…MRI reveals decreased T1 signal intensity with variable T2 signal intensity. The diagnosis is confirmed at surgical pathologic analysis after surgical resection for a symptomatic hook of the hamate [41]. …”

Biomechanics of Proximal Hamate Autograft in Scaphoid Nonunion

“…[14][15][16] As the primary blood supply to the hamate arises from the dorsal transverse carpal arch, which is more distal, harvest of the proximal hamate does not pose a disruption to the blood supply. 17 However, there are no data analyzing the biomechanics of the contact between the proximal scaphoid and the distal radius articular surface after proximal hamate autograft reconstruction. The purpose of our study is to evaluate alteration in the contact pressures and contact areas in the radioscaphoid and radiolunate facets after proximal hamate autograft reconstruction in a cadaveric biomechanics model.…”