Fracture of the Body's Hamate Bone: Open Reduction Internal Fixation by Double Approach—A Case Report

Abstract

Hamate fractures are rare. Their treatment depends on the displacement and type of fracture. We present the case and surgical technique of a 33-year-old male patient, who is a manual worker, with a displaced fracture of the body of the hamate bone associated with dislocation of the fourth and fifth metacarpal (MC) bones. The patient was operated on with a double palmar and dorsal approach directly over the hamate and the body hook, respectively, which was performed to improve the control reduction and avoid damaging the neighboring vascular and nerve structures. The open reduction internal fixation (ORIF) was performed by inserting mini-screws in a dorsal to palmar direction. Later, the dislocations were reduced and fixed with Kirschner wires between the fourth and fifth MC bases, and between the fourth MC base and the capitate bone. The patient was discharged 2.5 months after the fracture. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire outcome measure was 5 points at 6 months postsurgery.

Resumen

Las fracturas del ganchoso son poco frecuentes y el tratamiento depende del desplazamiento y tipo de fractura. Se describe la actualidad del tema, y el caso y técnica quirúrgica de un varón de 33 años, trabajador manual que sufre una fractura desplazada del cuerpo del hueso ganchoso, con luxación asociada del 4° y 5° metacarpianos. El paciente fue intervenido realizando un doble abordaje volar y dorsal directo al gancho y cuerpo del ganchoso respectivamente para mejorar el control de la reducción y evitar el daño de las estructuras vasculo-nerviosas vecinas. Se osteosintetizó con tornillo desde dorsal a volar y redujeron y fijaron las luxaciones con agujas de Kirschner entre las bases del 4° y 5° MTC; y base de 4° MTC y hueso grande. Fue dado de alta a los 2,5 meses de la fractura. El cuestionario DASH fue de 5 puntos a los 6 meses post fractura.

Keywords

carpal fracture - carpometacarpal dislocation - double dorsal and palmar approach - hamate fracture - open reduction internal fixation

Palabras Clave

fractura del ganchoso - fractura del carpo - reducción abierta y fijación interna - luxación carpometacarpiana - doble abordaje dorsal y volar

• References

• 1 Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am 2014; 39 (04) 785-791 , quiz 791
• 2 Hirano K, Inoue G. Classification and treatment of hamate fractures. Hand Surg 2005; 10 (2-3): 151-157
• 3 Sarabia Condés JM, Ibañez Martínez L, Sánchez Carrasco MA, Carrillo Julia FJ, Salmerón Martínez EL. Hamate fractures. Rev Esp Cir Ortop Traumatol 2015; t; 59 (05) 299-306
• 4 Guha AR, Marynissen H. Stress fracture of the hook of the hamate. Br J Sports Med 2002; 36 (03) 224-225
• 5 Kaneko K, Ono A, Uta S. , et al. Hamatometacarpal fracture-dislocation: distinctive three dimensional computed tomographic appearance. Chir Main 2002; 21 (01) 41-45
• 6 Scheufler O, Radmer S, Bogusch G, Andresen R. Minimal Invasive Fixation of Hamate Hook Fractures Through a Dorsal Percutaneous Approach Using a Mini Compression Screw: An Experimental Feasibility Study. Eur J Trauma Emerg Surg 2009; 35 (04) 397-402
• 7 Brinkman JN, Hartholt KA, de Vries MR. Multiple carpometacarpal dislocations and an associated fracture of the hamate: an uncommon injury. BMJ Case Rep 2016; 2016: 2016
• 8 Fredericson M, Kim BJ, Date ES, McAdams TR. Injury to the deep motor branch of the ulnar nerve during hook of hamate excision. Orthopedics 2006; 29 (05) 456-458
• 9 Maier RM, Hughes M, Katranji A. Patient with a Hook of the Hamate Fracture Presenting as Vascular Occlusion: Diagnosis Made with Bedside Ultrasound. J Emerg Med 2016; 51 (01) 63-65
• 10 Failla JM. Hook of hamate vascularity: vulnerability to osteonecrosis and nonunion. J Hand Surg Am 1993; 18 (06) 1075-1079