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Abul MS, Öztürk Ö, Hekim Ö, Eceviz E, Ergün S. The 'Shish-Kebab technique' in intra-articular fractures of the hamate body and concomitant 4th metacarpal base fracture. Eur J Trauma Emerg Surg 2024; 50:1083-1092. [PMID: 38200185 DOI: 10.1007/s00068-023-02424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE Hamate fractures are infrequent and often overlooked wrist injuries. Our objective is to present the Shish-Kebab method, a surgical approach utilized in the treatment of intra-articular Hamate body fractures occurring concurrently with fourth metacarpal base fractures and dislocations. METHODS This study was conducted at a single-center using a prospective design. It included patients aged 16-65 with Kim Type IIB fractures affecting the dominant side. Patients with the same features of fracture and carpometacarpal (CMC) instability findings were divided into two groups according to the success of the closed reduction procedure. In the conservative group (8 patients), all fractures and instability findings were successfully resolved with closed reduction and a short arm plaster cast. The surgical group (8 patients), comprising those requiring open reduction and internal fixation, underwent the application of the 'shish kebab' method. RESULTS At the 6th and 12th week follow-ups, no significant differences were observed between the groups concerning pVAS and QuickDash scores. However, upon examining the QuickDash scores, a statistically significant difference emerged between the 6th and 12th weeks within both the conservative (p = 0.017) and surgical (p = 0.012) groups in the intragroup analysis. Grip strength, measured as 83.78% of the contralateral side in the surgical group and 79.51% in the conservative group, did not exhibit a statistically significant difference (p = 0.462). CONCLUSION In the management of Hamate body intra-articular fractures and accompanying fourth metacarpal base fracture dislocations, good clinical results can be achieved with the 'Shish-Kebab' method in cases where closed reduction is unsuccessful.
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Affiliation(s)
- Mehmet Süleyman Abul
- Department of Orthopedics and Traumatology, Kartal Dr. Lütfi Kırdar City Hospital University of Health Sciences, Istanbul, Turkey
| | - Özer Öztürk
- Department of Orthopedics and Traumatology, Tuzla State Hospital, Istanbul, Turkey.
| | - Ömer Hekim
- Department of Orthopedics and Traumatology, Kartal Dr. Lütfi Kırdar City Hospital University of Health Sciences, Istanbul, Turkey
| | - Engin Eceviz
- Department of Orthopedics and Traumatology, Kartal Dr. Lütfi Kırdar City Hospital University of Health Sciences, Istanbul, Turkey
| | - Selim Ergün
- Department of Orthopedics and Traumatology, Kartal Dr. Lütfi Kırdar City Hospital University of Health Sciences, Istanbul, Turkey
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Ravoyard S, Andre L, Chammas M, Degeorge B. Palmar Dislocation Fracture of the Hamate: A Case Report and Review of Literature. J Wrist Surg 2024; 13:75-79. [PMID: 38264136 PMCID: PMC10803154 DOI: 10.1055/s-0042-1760126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/18/2022] [Indexed: 01/13/2023]
Abstract
Objective Hamate dislocations are rare lesions of the carpus, which make their diagnosis difficult or even missed, and their management non-standardized. Case Description We report the case of a 34-year-old victim of a high kinetic traffic accident. The initial evaluation revealed multiple fractures of both upper limbs, including a palmar fracture dislocation fracture of the hamate, without any vascular or nerve complications. Open surgical treatment via a dorsal approach allowed reduction and fixation of the hamate by temporary multiple pinning. At 12-month follow-up the patient had pain free motion of the wrist with a DASH score of 3. Radiographs showed evidence of proximal pole hamate sclerosis and carpo-metacarpal narrowing. Literature Review Owing to its rarity, literature on this topic is extremity limited. Various mechanisms have been described to explain these injuries, including dorsal pressure on the carpus associated with traction of the annular carpal ligament on its hamate insertion. Symptoms can be minimal and only three cases of nerve complications have been reported. Long-term outcomes following these injuries usually result in decrease in wrist motion and grip strength. Clinical Relevance The rarity of dislocations with or without hamate fracture favors the absence or the delay of diagnosis, which must lead to a precise radiographic analysis and to the implementation of a CT scan in case of high kinetics carpal trauma, even if it is poorly symptomatic. Level of Evidence Level 5, case study.
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Affiliation(s)
- Salomé Ravoyard
- Département de Chirurgie Orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, Montpellier, France
| | - Lisa Andre
- Département de Chirurgie Orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, Montpellier, France
| | - Michel Chammas
- Département de Chirurgie Orthopédique, unité de chirurgie du membre supérieur, de la main et des nerfs périphériques, CHU Lapeyronie, Montpellier, France
| | - Benjamin Degeorge
- Groupe OrthoSud, Clinique Saint Jean Sud-de-France, Saint Jean de Védas, France
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Kuptniratsaikul V, Luangjarmekorn P, Kerr S, Vinitpairot C, Kitidumrongsook P. Grip strength after hamate hook excision and reconstruction surgery: A biomechanical cadaveric study. J Biomech 2022; 141:111221. [PMID: 35908472 DOI: 10.1016/j.jbiomech.2022.111221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
Fractures of the hamate hook are common among professional athletes. The recommended treatment for this is hamate hook excision. The purpose of this study is to evaluate the hand grip strength after hamate hook resection at different levels. Six cadaver forearm flexor digitorum profundus tendons were loaded with 5- to 15-kilograms force and grip strength was subsequently measured. The same measurements were performed in five hamate hook conditions: normal, one-third, two-thirds, total hamate excision, and after perihamate ligament reconstruction. Multilevel mixed-effect models were used to calculate the scaling ratios after each surgical intervention and compared them to a normal hamate hook. A 25%, 36%, 47% reduction, and 7% increase (107% of baseline) in grip strength was found after one-third, two-thirds, total bone was resected, and after perihamate ligament reconstruction, respectively. The study shows an association between grip strength reduction and the level of hamate hook resection. Perihamate ligament reconstruction is recommended as it restores grip strength to normal.
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Affiliation(s)
- Vanasiri Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Pobe Luangjarmekorn
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Stephen Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Chaiyos Vinitpairot
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Pravit Kitidumrongsook
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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Dual Intra-Articular Fracture of the Body and Hook of Hamate: A Delayed Presentation. Case Rep Surg 2022; 2022:6774826. [PMID: 35198256 PMCID: PMC8860548 DOI: 10.1155/2022/6774826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Abstract
Fractures of the hamate bone are an unusual clinical entity. Dual fractures involving both the body and the hook of the hamate are even more unique, with only two previous cases described in the literature, to our knowledge. Clinicians are often unfamiliar with the presenting signs of this unusual injury, and subsequently, diagnosis is often delayed or missed entirely. We describe the case of a 19-year-old male who sustained an intra-articular body of hamate fracture with an ipsilateral hook of hamate fracture in his dominant hand. He presented 10 days following the initial injury and was managed with open reduction and internal fixation (ORIF).
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Price MB, Vanorny D, Mitchell S, Wu C. Hamate Body Fractures: a Comprehensive Review of the Literature. Curr Rev Musculoskelet Med 2021; 14:475-484. [PMID: 34932201 PMCID: PMC8733130 DOI: 10.1007/s12178-021-09731-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Due to the rarity and often discrete nature of hamate body fractures, timely diagnosis requires a high level of suspicion on the part of the clinician. Here, the authors have compiled the findings from 6 cohort studies and 33 case reports describing hamate body fractures in order to summarize the natural history, management, and outcomes of these infrequent injuries. RECENT FINDINGS Fractures of the hamate body typically occur in the coronal plane through axial loading of the metacarpals or loading in the transverse plane by a compressive force. Standard radiographs of the wrist frequently miss hamate fractures. Oblique and carpal tunnel views can be obtained when a fracture of the hamate is suspected. Advanced imaging with high-resolution computed tomography should also be considered if radiographs are negative and high suspicion for fracture remains or for the purpose of pre-operative planning. Co-existing injuries often include subluxation or dislocation of the 4th and 5th metacarpals with or without fracture. Non-displaced injuries that are stable may be treated non-operatively with immobilization. Displaced or unstable fracture patterns typically require closed reduction and percutaneous pinning versus open reduction internal fixation in order to restore anatomical alignment and maximize outcomes. Hamate body fractures are uncommon fractures of the carpus. When appropriately treated, patients with hamate body fractures usually recover full pain-free range of motion and preserved grip strength. Complications are usually secondary to late presentation or noncompliance.
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Affiliation(s)
- M. Brent Price
- Department of Orthopedic Surgery, Hand and Upper Extremity Surgery, Baylor College of Medicine, Houston, TX USA
| | - Dallas Vanorny
- Department of Orthopedic Surgery, Hand and Upper Extremity Surgery, Baylor College of Medicine, Houston, TX USA
| | - Scott Mitchell
- Department of Orthopedic Surgery, Hand and Upper Extremity Surgery, Baylor College of Medicine, Houston, TX USA
| | - Chia Wu
- Department of Orthopedic Surgery, Hand and Upper Extremity Surgery, Baylor College of Medicine, Houston, TX USA
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Kim H, Kwon B, Kim J, Nam K. Isolated hook of hamate fracture in sports that require a strong grip comprehensive literature review. Medicine (Baltimore) 2018; 97:e13275. [PMID: 30431614 PMCID: PMC6257646 DOI: 10.1097/md.0000000000013275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of the study was to report characteristics of isolated hook of hamate fractures related to sports that require a strong grip and to identify factors affecting early diagnosis and recovery period. METHODS A comprehensive literature search was conducted using MEDLINE, EMBASE, SCOPUS, Web of Science, the Cochrane Central Register of Controlled Trials, the World Health Organization International Clinical Trials Registry Platform, and the clinical trials registry and database of the US National Institutes of Health (ClinicalTrials.gov). There were no limits on the language or year of publication.This article included case reports and literature reviews for patients with isolated hook of hamate fractures related to sports that require a strong grip from 1977 to 2016.Two experienced reviewers extracted data from each study. The following data were extracted: sample size, patient's characteristics, cause of injury, injury side, time to diagnosis and symptoms, physical examination results, diagnostic work-up, treatment, complications, and recovery period. RESULTS A total of 21 case reports and literature reviews with 120 patients satisfied our inclusion criteria. There was no significant difference in the time to diagnosis between the group before computed tomography (CT) was widely used and the group after CT was widely used. Recovery period showed a positive relationship with age (coefficient = 0.418, P < .01), time from injury to diagnosis or surgery (coefficient = 0.206, P < .05), and type of athlete (coefficient = 0.270, P < .01). On multiple stepwise regression analysis, recovery period was significantly associated with age (β = 0.418, P = .00), but not with time from injury to diagnosis or surgery. CONCLUSIONS Advance in diagnostic techniques does not guarantee early diagnosis of hook of hamate fractures. Strong suspicion of the disease with physical examination and carefully hearing patient's history are important for early diagnosis and management for patients with hook of hamate fractures.
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Affiliation(s)
- Heejae Kim
- Departments of Physical Medicine and Rehabilitation, Dongguk University College of Medicine, Gyeonggi-do
| | - Bumsun Kwon
- Departments of Physical Medicine and Rehabilitation, Dongguk University College of Medicine, Gyeonggi-do
| | - Jihyun Kim
- Department of Pediatrics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Kiyeun Nam
- Departments of Physical Medicine and Rehabilitation, Dongguk University College of Medicine, Gyeonggi-do
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Abstract
OBJECTIVE The purposes of this article are to review hook of the hamate anatomy, describe the imaging features of the spectrum of pathologic conditions, and discuss the pearls and pitfalls of imaging for clinical decision making for pathologic entities affecting the hook of the hamate. CONCLUSION Knowledge of the anatomy, imaging appearance, and clinical management of hook of the hamate abnormalities is important for radiologists in guiding the care of patients with ulnar-sided wrist symptoms.
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Cecava ND, Finn MF, Mansfield LT. Subtle radiographic signs of hamate body fracture: a diagnosis not to miss in the emergency department. Emerg Radiol 2017; 24:689-695. [PMID: 28616787 DOI: 10.1007/s10140-017-1523-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
Hamate fractures are estimated to represent 1.7% of all carpal fractures and can occur at the hamulus (hook) or hamate body depending on mechanism of injury. Fractures of the hamate body can be exceedingly difficult to identify on standard wrist and hand radiographs in the emergency department. If the diagnosis is missed in the emergency department, orthopedic referral is often delayed. This can result in lasting functional disability for the patient, as these fractures have a propensity to destabilize the fourth and fifth carpometacarpal (CMC) joints. In this pictorial essay, we present six radiographic signs indicative of hamate body fracture with computed tomography (CT) imaging correlation. Injury mechanism and fracture classification schemes are portrayed to aid in the understanding of these injuries. Once radiographs raise suspicion for a hamate body fracture, further characterization with CT and orthopedic referral is paramount. Goals of orthopedic management include reestablishment of the fourth and fifth CMC articular surface, stabilization of the CMC joints, and appropriate treatment of concomitant soft tissue injury.
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Affiliation(s)
- Nathan D Cecava
- Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA.
| | - Mary F Finn
- Royal Air Force Lakenheath Hospital, Suffolk, UK
| | - Liem T Mansfield
- Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA.,Uniformed Services University of Health Sciences, Bethesda, MD, USA
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Athanasiou V, Iliopoulos ID, Pantazis K, Panagopoulos A. Fracture of the Body of the Hamate With Dorsal Dislocation of the 4 th and 5 th Metacarpals: A Case Report. Open Orthop J 2017; 11:447-451. [PMID: 28660003 PMCID: PMC5470060 DOI: 10.2174/1874325001711010447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Solitary fractures of the body of the hamate are rare. Their diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination. Case report: We present a case of a 36-year-old male patient who sustained an intraarticular fracture of the body of the hamate along with dorsal dislocation of the 4th and 5th metacarpals on his right dominant hand. Through a dorsal surgical approach, he underwent ORIF of the hamate with screws and stabilization of the dislocated 4th and 5th metacarpals with KW. At his last follow-up appointment, 18 months postoperatively, he had no pain, almost full range of motion on his fingers and a Mayo Wrist score of 90 points. Conclusions: Hamate fractures are rare entities that can cause significant patient morbidity if not recognized and treated appropriately.
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Affiliation(s)
- Vasilis Athanasiou
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - Ilias D Iliopoulos
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - Konstantinos Pantazis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - Andreas Panagopoulos
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
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