Lessons to be learned from a missed case of Hamate fracture: a case report

Abstract

IntroductionWe report the case of a missed fracture through the body of the hamate bone, only detected on a later, mistakenly taken 30° oblique x-ray view. This case highlights some of the problems encountered with traditional x-ray views, and the need to consider oblique views as either standard procedure or as an adjunct where clinical suspicion remains high even in the presence of normal x-rays.Case presentationA healthy 26-year-old Caucasian male fell whilst jogging, suffering a low velocity injury to his right hand. Initial accident and emergency examination and x-rays failed to demonstrate a fracture. At clinic, anteroposterior and carpal tunnel radiographs showed no fracture, however a mistakenly taken oblique x-ray revealed a displaced hamate body fracture.ConclusionThe authors believe that where a hamate fracture is suspected, an oblique x-ray view should be considered as part of the initial diagnostic investigations. Furthermore an oblique x-ray view is of particular use when clinical suspicion for hamate fracture remains high in the light of otherwise normal x-rays.

Combined Intraarticular Fracture of the Body and the Hook of Hamate: An Unusual Injury Pattern

“…Hamate fractures are frequently missed at the time of presentation because of paucity of signs and symptoms, relative rareness of the injury pattern, and complex carpal anatomy [3,4,9,10]. Ebraheim et al reported a mean delay of 10 days for the diagnosis from the time of injury [4].…”

“…Ebraheim et al reported a mean delay of 10 days for the diagnosis from the time of injury [4]. The importance of oblique views of wrist and high resolution CT for early diagnosis has been stressed in the literature [9,11].…”

Fracture du hamatum chez un boxeur professionnel

“…Les fractures de type II sont moins courantes [5]. Celles de type I sont liées le plus souvent au sport de raquettes et de bâtons (tennis, golf.…”

“…Le diagnostic est essentiellement radiologique reposant sur des clichés de face, de profil, et surtout des incidences obliques à 30-45 • [5]. La TDM reste l'examen de choix dans le diagnostic de ce type de fracture en précisant les traits fracturaires et le nombre de fragments ainsi que leur possible déplacement [2].…”

“…La TDM reste l'examen de choix dans le diagnostic de ce type de fracture en précisant les traits fracturaires et le nombre de fragments ainsi que leur possible déplacement [2]. Dans une étude faite sur 18 mains de cadavres, la TDM avait une sensibilité de 100 % et une spécificité de 94,4 % alors que la radiographie conventionnelle a montré une sensibilité de 72,2 % et une spécificité de 88,8 % [5]. Notre cas confirme l'avantage des incidences obliques et la nécessité de la TDM dans le diagnostic de cette fracture.…”