Coronal Fracture of the Body of the Hamate

Ebraheim, Nabil A.; Skie, Martin; Savolaine, Edward R.; Jackson, William T.

doi:10.1097/00005373-199502000-00004

Cited by 42 publications

(52 citation statements)

References 9 publications

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“…2 Computerised axial tomography is a useful adjunct in the diagnosis of these injuries. [4][5][6][7]9 Early investigation with three dimensional computed tomography (3D-CT) has been advocated. 7 In this particular case, multiple axial views provided adequate definition of the fracture lines.…”

Section: Discussionmentioning

confidence: 99%

“…3 Due to the mechanism of injury, an associated carpometacarpal dislocation involving the fourth and fifth metacarpal bases may be present. [3][4][5]7 This fracture pattern is inherently unstable because of the action of the long flexor and extensor tendons. Early diagnosis is essential to minimize the risk of painful arthritis, muscle imbalance and potential loss of grip strength.…”

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confidence: 99%

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Fourth metacarpal base fracture in association with coronal hamate fracture

et al. 2005

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A 26-year-old male presented to the outpatient clinic complaining of pain in the dorsum of his right hand. He was a right hand dominant security guard who had sustained a work related injury 4 days previously. The patient was kicked on the dorsum of the right hand. The injury occurred with his hand in the position of a clenched fist. No other significant injuries were incurred. He was unable to extend the fingers at the level of the metacarpophalangeal joints due to severe pain at the dorsal carpometacarpal level. There was no associated neurovascular deficit and the skin overlying a region of significant contusion was intact. Plain radiographs of the right hand had been obtained in the accident and emergency department on the day after the event and the case had been treated with an ulnar gutter slab in the manner of a metacarpal base fracture. Anteroposterior and lateral radiographs taken at the outpatient clinic showed evidence of an undisplaced fourth metacarpal base fracture (Figs. 1 and 2) but no unequivocal evidence of carpal involvement. A clinically disproportionate degree of swelling on the dorsum of the hand was present. A CT scan showed (Fig. 3) a vertical split fracture of the fourth metacarpal with dorsal displacement. A comminuted, displaced dorsal hamate fracture was also evident with dorsal displacement.The patient underwent open reduction and internal fixation of the hamate fracture through a dorsal approach. The fracture was fixed with two Liebinger screws (Fig. 4). The affected hand was immobilised for a 2-week period before commencing full mobilisation. Three months following the injury, movement of the metacarpophalangeal joints was painfree and grip strength is comparable to the contralateral limb. The fracture is now fully healed. DiscussionHamate fractures are relatively rare representing 2-4% of carpal fractures. 8 Coronal fractures of the hamate represent a small subset of this fracture group. They can be difficult to diagnose as plain radiographs can fail to clearly demonstrate the abnormality. 3 Due to the mechanism of injury, an associated carpometacarpal dislocation involving the fourth and fifth metacarpal bases may be present. [3][4][5]7 This fracture pattern is inherently unstable because of the action of the long flexor and extensor tendons. Early diagnosis is essential to minimize the risk of painful arthritis, muscle imbalance and potential loss of grip strength. This case is of interest as it also involves an associated dorsally displaced fourth metacarpal base.

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Section: Discussionmentioning

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Fourth metacarpal base fracture in association with coronal hamate fracture

et al. 2005

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“…A prior case was treated successfully with open reduction and K-wire fixation of both the hamate and capitate. 2 In the limited number of published case series of coronal hamate fractures most investigators have observed good results with open reduction and internal fixation using either K-wires, 2-5 lag screws, 6 or a Herbert screw. 7 One attempt at closed treatment resulted in residual fourth and fifth metacarpal dorsal subluxation after the patient was noncompliant with splinting.…”

Section: Discussionmentioning

confidence: 99%

“…1 A fracture in the coronal plane of the capitate has been described and was associated with a coronal hamate fracture. 2 We present a case of a fracture of the capitate in the coronal plane in conjunction with a fracture of the hamate in the coronal plane treated satisfactorily with open reduction and internal fixation of the hamate only. The diagnosis was delayed because of the rarity of the injury.…”

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Simultaneous Fractures of the Capitate and Hamate in the Coronal Plane: Case Report

Robison

Kaye

2005

The Journal of Hand Surgery

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“…As such, diagnosis has been delayed as long as three months postinjury in some cases (4). It has been suggested that when a boxer's fracture is not found after a significant punching injury, fracture of the hamate should be suspected (3). Pain at the ulnar side of the hand in the absence of routine radiological findings, as well as fractures of the fourth metacarpal base, should warrant an oblique x-ray.…”

Section: Discussionmentioning

confidence: 99%

Coronal fractures of the body of the hamate: Two case reports

Binhammer¹,

Rao²

1998

CAN J PLAST SURG

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Fractures of the hamate were classified by Milch (1) into body fractures and hook fractures; fractures of the body of the hamate were subdivided into those occurring on the radial side and those occurring on the ulnar side of the hook. Bowen (2) presented a hamate fracture in the coronal plane and, therefore, added a third category -fractures to the body of the hamate. The two cases described in this report are examples of this rare type of fracture; both were associated with disarticulations at the base of the fourth and fifth metacarpals. Open reduction and internal fixation led to rapid recovery in terms of stabilization of the hamatometacarpal joint and restoration of hand function. CASE PRESENTATIONS Case 1A 29-year-old, right-hand dominant woman was referred five days after punching a steel door with her closed right fist. She was seen by physicians at the emergency department of a local hospital, where she was placed in a fibreglass splint after reduction of the fifth metacarpal.Follow-up physical examination revealed minimal to moderate swelling and ecchymosis over the base of her right fifth metacarpal. X-rays revealed a hamate intra-articular fracture with the fifth carpometacarpal joint (Figure 1). Displacement was noted to be approximately 3 to 4 mm. An open reduction was recommended to reduce the dislocated fragment of the hamate, and eight days after the injury, the patient underwent open reduction and internal fixation.Maintenance reduction of the fifth metacarpal was achieved by two 1.1 mm Kirschner wires driven between the fourth and fifth metacarpals. The dislocated fragment of the hamate was positioned and fixed in place with a 0.7 mm Kirschner wire. Two 1.2 mm screws were then used with a plate over the fragment, and the 0.7 mm Kirschner wire was removed. The hand and wrist were immobilized by a volar plaster splint for three weeks, at which time it was replaced by a short-arm cast to immobilize the extremity for an additional three weeks. Six weeks after the operation, the Kirschner wires were removed (Figure 2). The patient returned to full activities by 12 weeks after surgery and was asymptomatic when seen at eight months postsurgery.Can J Plast Surg Vol 6 No 2 Summer 1998 81 CASE REPORTCorrespondence: Dr PA Binhammer, Sunnybrook Health Science Centre, H-210, 2075 Bayview Avenue, North York, Ontario M4N 3M5. Telephone 416-480-6731, fax 416-480-6800, e- Coronal fracture of the body of the hamate with associated dorsal dislocation at the bases of the fourth and fifth metacarpals is rare. Two cases of this injury, treated with open reduction and internal fixation, are reported. As well, other reports of coronal hamate fractures are reviewed.

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Coronal Fracture of the Body of the Hamate

Cited by 42 publications

References 9 publications

Fourth metacarpal base fracture in association with coronal hamate fracture

Fourth metacarpal base fracture in association with coronal hamate fracture

Simultaneous Fractures of the Capitate and Hamate in the Coronal Plane: Case Report

Coronal fractures of the body of the hamate: Two case reports

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