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Dolan JD, Shiver L, Wallace D, Whitehead J, Wood M, Fulcher SM. Isolated Osseous Excision in the Adult Carpus: A Narrative Review. J Hand Microsurg 2024; 16:100041. [PMID: 38855507 PMCID: PMC11144647 DOI: 10.1055/s-0043-1769748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Various pathologies of the adult carpus result in clinical scenarios where excision can be considered and even recommended. In the appropriate patient population, isolated carpal excision can alleviate pain and improve mobility. Excisions of the pisiform, trapezium, and trapezoid have abundant literature evidence to support positive long-term functional outcomes. In contrast, isolated excision of the capitate, hamate, and triquetrum has limited support in the literature secondary to compromise of carpal mechanics and lead to recurrent pain. Additionally, isolated scaphoid and lunate excision are best avoided secondary to carpal collapse and should be paired with concomitant stabilizing procedures in the carpus. This article provides a comprehensive literature review of isolated excision of each osseous carpal bone, their indications, and previously assessed outcomes.
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Affiliation(s)
- Joshua D. Dolan
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, Georgia, United States
| | - Luke Shiver
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, Georgia, United States
| | - Doyle Wallace
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, Georgia, United States
| | - Jonathon Whitehead
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, Georgia, United States
| | - Matthew Wood
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, Georgia, United States
| | - S. Mark Fulcher
- Department of Orthopaedic Surgery, Medical College of Georgia, Augusta, Georgia, United States
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2
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Weber DM, Kraus R, Wirth-Welle R, Andreisek G, Gnannt R, Guéro S, Neeser HR, Seiler M. Paediatric fractures of carpal bones other than the scaphoid. HAND SURGERY & REHABILITATION 2023; 42:406-412. [PMID: 37356568 DOI: 10.1016/j.hansur.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVES Fractures of carpal bones other than the scaphoid are rare in children. The aim of this study was to analyze results and identify risk factors for an unfavorable outcome. MATERIAL AND METHODS Children and adolescents up to the age of 16 years who sustained a carpal fracture other than in the scaphoid between 2004 and 2021 were reviewed in this single-center retrospective study. RESULTS In a series of 209 children and adolescents with carpal fractures, 22 had fractures other than the scaphoid. Mean age was 13 years (range 8-16) years, with a total of 41 fractures, with highest incidences for the capitate (10), trapezium (6), triquetrum (4) and pisiform (4). Twenty-nine of these 41 fractures were missed on initial X-ray. Non-displaced fractures were treated with a short arm spica cast including the thumb. Four patients were operated on for displacement fracture or carpometacarpal subluxation. All fractures united, and patients returned to full activities. At the final consultation at a median 14 months (range 6-89) post-injury, all patients with non-displaced fractures were free of symptoms, with excellent Mayo Wrist Scores (MWS). However, three patients with operated trapezium fractures developed early radiological signs of osteoarthritis, two of them with residual pain and MWS rated only good. CONCLUSION Non-displaced pediatric carpal fractures treated by forearm cast have excellent prognosis. Fractures of the trapezium with displacement or first carpometacarpal subluxation incur a risk of osteoarthritis despite anatomical reduction and internal fixation.
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Affiliation(s)
- Daniel M Weber
- Division of Paediatric Hand Surgery and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Ralf Kraus
- Klinikum Bad Hersfeld, Seilerweg 29, Bad Hersfeld, Germany.
| | - Ruth Wirth-Welle
- Division of Hand Surgery, Kantonsspital, Frauenfeld, Pfaffenholzstrasse 4, 8501 Frauenfeld, Switzerland.
| | - Gustav Andreisek
- Department of Radiology, Kantonsspital, Münsterlingen, Spitalcampus 1, 8596 Münsterlingen, Switzerland.
| | - Ralph Gnannt
- Paediatric Department of Radiology and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Stéphane Guéro
- Division of Paediatric Orthopedics, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.
| | - Hannah R Neeser
- Division of Paediatric Hand Surgery and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
| | - Michelle Seiler
- Paediatric Emergency Department and Children's Research Centre, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland.
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3
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Lai CC, Fang HW, Chang CH, Pao JL, Chang CC, Chen YJ. Unusual capitate fracture with dorsal shearing pattern and concomitant carpometacarpal dislocation with a 6-year follow-up: A case report. World J Clin Cases 2023; 11:2060-2066. [PMID: 36998955 PMCID: PMC10044964 DOI: 10.12998/wjcc.v11.i9.2060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/10/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Isolated capitate fractures are rare carpal fractures. Following high-energy injuries, capitate fractures are usually associated with other carpal fractures or ligament injuries. The management of capitate fractures depends on the fracture pattern. Here, we report an unusual capitate fracture with a dorsal shearing pattern and concomitant carpometacarpal dislocation, with a 6-year follow-up. To the best of our knowledge, this fracture pattern and surgical management have not been previously reported.
CASE SUMMARY A 28-year-old man presented with left-hand volar tenderness and decreased grip strength that persisted for one month after a traffic accident. Radiography showed a distal capitate fracture with carpometacarpal joint incongruence. Computed tomography (CT) revealed a distal capitate fracture with carpometacarpal joint dislocation. The distal fragment was rotated by 90° in the sagittal plane, and an oblique shearing fracture pattern was noted. Open reduction and internal fixation (ORIF) with a locking plate were performed using the dorsal approach. The imaging studies performed 3 mo and 6 years following surgery revealed a healed fracture, and the Disabilities of the Arm, Shoulder, and Hand and visual analog scale scores were significantly improved.
CONCLUSION CT can detect capitate fractures with dorsal shearing pattern and concomitant carpometacarpal dislocation. ORIF using a locking plate are possible.
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Affiliation(s)
- Chien-Cheng Lai
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei 106, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei 106, Taiwan
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan 320, Taiwan
| | - Jwo-Luen Pao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Chun-Chien Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Yeong-Jang Chen
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 243, Taiwan
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4
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Higgins JP, Guarino GM, Belyea CM, Tintle SM. Lateral Femoral Trochlea Flap Reconstruction of the Proximal Capitate: An Assessment of Congruity and Description of Technique. J Hand Surg Am 2023; 48:149-157. [PMID: 35870956 DOI: 10.1016/j.jhsa.2022.04.015] [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: 09/07/2021] [Revised: 03/02/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE We examined morphologic similarities of the medial lateral femoral trochlea (MFT) and lateral femoral trochlea (LFT) osteochondral flaps for reconstruction of the proximal capitate. METHODS Magnetic resonance imaging scans of the wrists and ipsilateral knees of 10 young healthy volunteers were obtained. Three morphologic parameters were investigated, comparing the MFT and LFT harvest sites to the capitate proximal pole. The correspondingly relevant surgical planes were compared. The coronal plane radius of curvature (ROC) of the capitate was compared with the sagittal planes of the MFT and LFT. The sagittal plane ROC of the capitate was compared to the axial planes of the MFT and LFT. The angular relationship between the dorsal cortical surface of the capitate and the proximal pole cartilage (proximal dorsal capitate pitch) was compared to the corresponding angles between the cortical bone and convex cartilage on the LFT and MFT. RESULTS The average ratios of ROC for the coronal planes of the capitate to the MFT (0.61) and LFT (0.58) were similar. The average ratios of ROC for the sagittal planes of the capitate to the MFT (0.57) and LFT (0.86) were also similar. The proximal dorsal capitate pitch demonstrated greater similarity to the corresponding shape of the LFT (angular ratio, 1.01) than to that of the MFT (angular ratio, 0.74). CONCLUSIONS The LFT and MFT demonstrate similar congruity to the proximal capitate in the sagittal and coronal planes of the wrist. The LFT dorsal pitch closely approximates the relationship of the proximal capitate pole to its dorsal cortical surface. CLINICAL RELEVANCE In capitate fracture, fracture nonunion, or avascular necrosis, both the MFT and LFT demonstrate similarity to the proximal convex capitate morphology. The relationship between the cortical and chondral surfaces of the LFT is morphologically very similar to that of the proximal capitate.
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Affiliation(s)
- James P Higgins
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
| | - Gianna M Guarino
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Christopher M Belyea
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Scott M Tintle
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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5
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Lynch D, Mickley JP, Gordon A, Roebke AJ, Goyal KS. The Effect of Derotational Kirschner Wires on Fracture Gap Reduction With Variable-Pitch Headless Screws. J Hand Surg Am 2023; 48:86.e1-86.e7. [PMID: 34802813 DOI: 10.1016/j.jhsa.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/06/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We evaluated the impact of angled derotational Kirschner wires (K-wires) on fracture gap reduction with variable-pitch headless screws. METHODS Fully threaded variable-pitch headless screws (20 and 28 mm) were inserted into "normal" bone models of polyurethane blocks. In separate trials, derotational K-wires were inserted at predetermined angles of 0°, 15°, 30°, and 40° and compared with each other, with no K-wire as a control. Fluoroscopic images taken after each screw turn were analyzed. The optimal fracture gap closure, initial screw push-off, and screw back-out gap creation were determined and compared at various derotational K-wire angles. RESULTS Initial screw push-off due to screw insertion and screw back-out gap creation were not significantly affected by the angle of the derotational K-wire. With a 20-mm screw, only a 40° derotational K-wire led to significantly less gap closure compared with control and with 0°, 15°, and 30° derotational K-wires. It led to an approximately 60% decrease in gap closure compared with no K-wire. With the 28-mm screw, compared with no K-wire, 15° and 30° derotational K-wires led to statistically significant decreases in gap closure (approximately 25%), whereas a 40° derotational K-wire led to an approximately 60% decrease. With the 28-mm screw, the 40° derotational K-wire also led to a statistically significant smaller gap closure when compared with 0°, 15°, and 30° derotational K-wires. CONCLUSIONS A derotational K-wire placed in parallel to the planned trajectory of a headless compression screw does not affect fracture gap closure. With greater angulation of the derotational K-wire, the fracture gap is still closed, but less tightly. CLINICAL RELEVANCE Derotational K-wires can help prevent fracture fragment rotation during headless compression screw insertion. At small deviations from parallel (≤30°), fracture gap closure achieved by the screw is minimally affected. At greater angles (ie, 40°), fracture gap closure may be substantially reduced, preventing fracture compression.
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Affiliation(s)
- Daniel Lynch
- Ohio State University College of Medicine, Columbus, OH
| | | | - Adam Gordon
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Austin J Roebke
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Kanu S Goyal
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH.
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Ferreira Branco D, Bouvet C, Hamard M, Yves Beaulieu Pr J, Alexandre Poletti Pr P, Boudabbous S. Reliability of radio-ulnar and carpal alignment measurements in the wrist between radiographs and 3D imaging. Eur J Radiol 2022; 154:110417. [DOI: 10.1016/j.ejrad.2022.110417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
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Abstract
Acute and subacute wrist trauma predominantly consist of fractures of the distal radius in elderly patients and most frequently carpal fractures (scaphoid, followed by triquetrum and hamatum) and avulsion fractures of the ulnar styloid in younger patients, especially in sports-related injuries but also in work activities. The initial radiographs may miss the fractures and result when untreated in complications as nonunion, osteonecrosis, and degenerative osteoarthritis. Fractures of the distal radius and of the scaphoid may be associated with ligament injuries, most frequently the scapholunate complex, which are often overlooked at the emergency department. Patients without osseous injuries may present intrinsic and extrinsic ligament tears that may lead to carpal instability when they are clinically and/or radiologically missed. Therefore, in acute and subacute setting, computed tomography may be helpful for the detection of subtle fractures, and magnetic resonance imaging, for the early diagnosis of occult fractures and ligament injuries.
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8
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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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9
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De Jonge MC, Assink J, Vanhoenacker FM. Acute Bony Injuries of Hand and Wrist. Semin Musculoskelet Radiol 2021; 25:277-293. [PMID: 34374063 DOI: 10.1055/s-0041-1729151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. At the carpal level, scaphoid fractures are the most common followed by fractures of the dorsal side of the triquetrum. The metacarpals often fracture, most commonly the base of the thumb and the subcapital region of the fifth metacarpal. In the fingers, we encounter many different types of fractures, often avulsions reflecting underlying soft tissue pathology (e.g., mallet finger). Dislocations are common in the fingers, predominantly in the distal interphalangeal joints. From an imaging standpoint, conventional radiography is always the initial examination. Complex (intra-articular) fractures, fracture-dislocation injuries, and a strong clinical suspicion of radiographically occult fractures need to be further evaluated for decision making regarding treatment. Computed tomography is the primary imaging modality of choice for the first two. In the latter, magnetic resonance imaging can be preferable, depending on clinical suspicion and the local situation in the associated hospital.
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Affiliation(s)
- Milko C De Jonge
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Joeri Assink
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium.,Department of Radiology, Ghent University Hospital, Ghent, Belgium
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10
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Poggetti A, Suardi C, Lauri G, Espen D, Bigazzi P, Pfanner S. How to ease the fixation of carpal bones? Twenty-four lesions treated by 1,5 mm headless compression screws. J Clin Orthop Trauma 2021; 18:56-60. [PMID: 33996449 PMCID: PMC8099553 DOI: 10.1016/j.jcot.2021.03.022] [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: 11/05/2020] [Revised: 02/24/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Carpal bone lesions are common, even in acute injuries or as sequalae of missed fractures. If not correctly diagnosed and treated, can lead to loss of function, especially in active patients. The surgical management remain difficult particularly in case of small, atypical or non-unions fragments. The treatment of heterogenic shape fractures should require a fragment specific fixation using, traditionally, Kirschner-wire (K-wire). This method of treatment remains the most popular but could be prone to some complication as: not stable fixation, need to long time immobilization and wire mobilization. Methods Nineteen patients presented with carpal bone lesions were treated by the use of HCS 1,5 mm headless compression screws. Patients were evaluated post-operative by Patient-Rated Wrist Evaluation (PRWE), the Visual Analogic Scale (VAS), Quick-DASH Score and the grip strength was measured by Jamar dynamometer. RESULTS Authors observed improvement of pain control and common activity; fine movements were restored; we observed no post-operative functional instability. CONCLUSIONS HCS 1,5 mm headless compression screws are suitable and smart technique to treat these uncommon fractures to achieve a stable primary fixation and allow an early mobilization and conciliate the versatility of K-wire and the compression action due to screws also in small bone fragment.
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Affiliation(s)
- Andrea Poggetti
- Hand and Reconstructive Microsurgery Unit, A.O.U.C, Florence, IT, Italy
| | - Chiara Suardi
- Hand and Reconstructive Microsurgery Unit, A.O.U.C, Florence, IT, Italy,Corresponding author. Largo P. Palagi 1, 50139 Firenze, Italy.
| | - Giulio Lauri
- Hand and Reconstructive Microsurgery Unit, A.O.U.C, Florence, IT, Italy
| | - David Espen
- Hand Team Unit, Marienklinik, Bolzen, IT, Italy
| | - Prospero Bigazzi
- Hand and Reconstructive Microsurgery Unit, A.O.U.C, Florence, IT, Italy
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11
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Estermann L, Roner S, Schweizer A. Triquetrum osteotomy to approach an otherwise inaccessible coronal malunion of the hamate. HAND SURGERY & REHABILITATION 2021; 40:519-523. [PMID: 33864940 DOI: 10.1016/j.hansur.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/07/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
Fractures of the hamate are rare, and a clear treatment algorithm does not exist. Nonetheless, surgical treatment is generally recommended for displaced fractures using a dorsal approach. There is also a lack of data on hamate malunion. We present a case of a 28-year-old female with a coronal malunion of the hamate and hamate hook fracture. Because the triquetrum prevented direct access to the fracture, we planned and undertook a transtriquetral coronal osteotomy based on three-dimensional computed tomography imaging data. After removing the bone callus, reduction was possible with subsequent fixation. We recommend performing a transtriquetral osteotomy to treat an otherwise inaccessible fracture or malunion of select hamate fractures.
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Affiliation(s)
- L Estermann
- Department of Hand Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - S Roner
- Department of Hand Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
| | - A Schweizer
- Department of Hand Surgery, Balgrist University Hospital, Forchstrasse 340, 8008 Zurich, Switzerland
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Guo RC, Cardenas JM, Wu CH. Triquetral Fractures Overview. Curr Rev Musculoskelet Med 2021; 14:101-106. [PMID: 33483875 PMCID: PMC7991068 DOI: 10.1007/s12178-021-09692-w] [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] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW The triquetrum is the second most commonly fractured carpal bone, comprising 15-18% of all carpal bone fractures. This review summarizes the current knowledge of triquetral fractures, including the anatomy and pathophysiology, evaluation and diagnosis, treatment and management, post-treatment outcomes, and complications. RECENT FINDINGS Triquetral fractures are frequently caused by impaction of the ulnar wrist after a fall on an outstretched hand or by avulsion of attached ligaments. There are three main types of triquetral fractures: dorsal cortical fractures, triquetral body fractures, and volar cortical fractures. Dorsal cortical fractures are the most common and are usually benign, while volar cortical fractures are the least common and can be problematic. Nonsurgical management is indicated for most triquetral fractures, which usually results in good outcomes. Surgical treatment is indicated for fractures with significant displacement or evidence of instability. Complications of triquetral fractures include non-union, triangular fibrocartilage complex injury, and pisotriquetral arthritis. While less common than scaphoid fractures, triquetral fractures should remain in the differential diagnosis for patients with ulnar-sided wrist pain after falling on an outstretched hand. Most triquetral fractures can be treated with immobilization, though they should be thoroughly evaluated due to their potential to result in instability, loss of motion, and arthrosis. Further research is needed to determine the best method of surgical treatment.
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Affiliation(s)
- Raymond C. Guo
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
| | - Justin M. Cardenas
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
| | - Chia H. Wu
- Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030 USA
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13
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Otake Y, Sukegawa K, Onuma K, Machida S, Iida R, Takaso M. Displaced isolated coronal shearing fracture of the trapezoid: a case report. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:50-55. [PMID: 33796623 PMCID: PMC7971332 DOI: 10.1080/23320885.2021.1894941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present a case of a displaced isolated coronal shearing trapezoid fracture, treated with open reduction and internal fixation using a headless compression screw after temporary second metacarpal-trapezoid and trapezium-trapezoid ligament detachment. Complete functional recovery was achieved. For trapezoid fractures, lateral and oblique X-ray views in supination are important.
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Affiliation(s)
- Yuya Otake
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koji Sukegawa
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Onuma
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shuhei Machida
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Riyo Iida
- Clinical Training Center, Kitasato University Hospital, Kanagawa, Japan
| | - Masashi Takaso
- Department of Orthopedic Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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14
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Transverse fractures through the body of the lunate with delay in consolidation. Experience with arthroscopic treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020. [DOI: 10.1016/j.recote.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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Shimizu H, Matsuhashi T, Fukushima A, Menjo Y, Hojo Y, Iwasaki N. Coronal Hamate Fractures with Carpometacarpal Dislocation Treated Effectively Using Headless Compression Screws with Percutaneous Pinning Fixation by Using the 2-Directional Approach: A Report of 2 Cases. JBJS Case Connect 2020; 10:e0361. [PMID: 32649122 DOI: 10.2106/jbjs.cc.19.00361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE Coronal shear fractures of the hamate are relatively rare injuries. Surgical intervention is recommended for displaced fractures. However, there is no established surgical procedure for the displaced coronal shear fractures of the hamate. Therefore, we present 2 cases of the displaced coronal hamate fracture with metacarpal dislocations, which were successfully managed with open reduction and internal fixation, using the headless compression screw by the 2-directional approach. CONCLUSION Our procedure ensured that the screw's distal end captured the hamate hook, and the displaced bone fragments were reduced considerably in both cases.
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Affiliation(s)
- Hirokazu Shimizu
- 1Department of Orthopaedic Surgery, Kushiro Rosai hospital, Kushiro, Japan 2Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Transverse fractures through the body of the lunate with delay in consolidation. Experience with arthroscopic treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2020; 64:421-427. [PMID: 32446753 DOI: 10.1016/j.recot.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/03/2020] [Accepted: 04/09/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIM Lunate traumatic fractures represent between 0.5% and 1% of carpal bone fractures. Transverse fracture through the body of the lunate (type V) are the least frequent and need surgical treatment if displaced, because it has a high risk of necrosis or pseudoarthrosis. The objective of this paper is to present our experience with arthroscopic treatment in patients with a delay in consolidation after a transverse fracture through the body of the lunate. METHODS Two clinical cases of delay in consolidation in transverse fracture through the body of the lunate are presented. Both cases have delay in consolidation. RESULTS Both fractures were misdiagnosed in initial simple radiographic exploration and were diagnosed with computerised tomography. Both patients were treated by debridement, bone grafting and osteosynthesis under arthroscopic control, obtaining a correct radiographic consolidation. CONCLUSION Arthroscopic treatment is a valid, effective and safe technique for the treatment of delay in consolidation of transverse fractures through the body of the lunate and avoids complications and soft tissues injury of the open surgery techniques.
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Xiao ZR, Zhang WG, Xiong G. Features of intra-hamate vascularity and its possible relationship with avascular risk of hamate fracture. Chin Med J (Engl) 2020; 132:2572-2580. [PMID: 31658154 PMCID: PMC6846259 DOI: 10.1097/cm9.0000000000000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The angiography with micro-computed tomography (micro-CT) has been proved its great advantages on investigating the intra-osseous vascularity of carpal bones. But few researches have focused on the intra-hamate vascularity. This study aimed to illustrate the intra-osseous arteries of the hamate and the relationship between the intra-hamate vascularity and the avascular risk of different types of hamate fractures. METHODS Six normal cadaveric hamates were investigated with red lead (Pb3O4) micro-CT angiography. The intra-osseous arteries of specimens were clearly enhanced and the three-dimensional model was reconstructed. In order to study the features of the arterial entrances and intra-hamate vascularity, the diameters, quantities, locations of enhanced arteries, and the locations of transversal/proximal pole fracture lines on the body of the hamate were statistically compared. Besides, in order to analyze the relationship between intra-hamate vascularities and different hamate fractures, 127 cases of hamate fractures who presented in our hospital from March 2003 to June 2017 were retrospectively studied. RESULTS A total of 94 cases were followed up (range: 4-37 months; mean: 12.4 months) effectively. The overall union rate of hamate fractures was as high as 92.6% (87 of 94 cases), while non-union of fracture on hamate hook was more common (P = 0.031). The arterial entrances were located around the dorsal, volar, radial, ulnar non-articular surfaces of the hamate body and the hook of the hamate. Generally, there were one to two trunk arteries on the volar non-articular surface and one to three trunk arteries on the dorsal non-articular surface. They formed one or two arterial arches, from which some branches were emitted and supplied the proximal parts. The intra-osseous vascularities of the hamate body were generally located in the radial part. The blood supply of the hook was mainly from the volar non-articular surface in most specimens. Hamate fractures could be classified into four types: fractures of the transversal/proximal pole, medial tuberosity, dorsal coronal of the hamate body, and fractures of the hamate hook. CONCLUSIONS This study showed new features of intra-hamate vascularity and the results will guide surgeons to reduce the vascular damage during the hamate fracture operations. The fracture lines of different types of hamate fractures may disrupt the intra-hamate arteries. The intra-hamate vascularities will have different influences on the avascular risks of different hamate fractures.
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Affiliation(s)
- Zi-Run Xiao
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
| | - Wei-Guang Zhang
- Department of Anatomy and Histology, Peking University Health Science Center, Beijing 100191, China
| | - Ge Xiong
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China
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van Rijckevorsel VA, Selles CA, van der Vlies CH, Cleffken BI, Schep NW. Functional Outcome following Headless Compression Screw Fixation for Hamate Fractures. J Wrist Surg 2020; 9:164-169. [PMID: 32257620 PMCID: PMC7113013 DOI: 10.1055/s-0039-1695765] [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: 03/18/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
Hamate fractures can be treated nonoperatively, with the percutaneous Kirschner wire (K-wire) fixation, or with excision of a fractured hook of the hamate. Screw fixation is less popular owing to the risk of iatrogenic ulnar nerve injury. The aim of this study was to present the functional results of patients with hamate fractures treated with headless compression screws (HCS). The primary outcome was the Michigan Hand Outcome Questionnaire (MHOQ) after at least 4 months of follow-up. Nine patients were included in this retrospective cohort study. A median MHOQ total score of 67% was reported (interquartile range [IQR]: 44-76). No complications were found during follow-up. HCS fixation is a safe alternative to treat hamate fractures with good functional outcome. This is a Level IV study.
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Affiliation(s)
| | - Caroline A. Selles
- Department of Hand and Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | | | - Berry I. Cleffken
- Department of Hand and Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Niels W.L. Schep
- Department of Hand and Trauma Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
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19
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20
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Hopkins A, Bowman SRA, Preketes AP, Dowd MB. Triquetral fractures—a retrospective, multi-centre study of management and outcomes. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.34239/ajops.v3n1.161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: This study examines triquetral fracture data from six hospital centres between 2009 and 2018. The study focuses on elements of triquetral fracture management within these six centres, outlining common fracture patterns, the short-term and long-term outcomes and the common mechanisms of injury. To the authors’ knowledge, this is the largest cohort of triquetral fractures studied to date and outlines investigation recommendations for improved identification of these fractures.
Methods: Data was obtained by reviewing the charts of patients presenting to emergency departments within the Nepean and Blue Mountains local health district of New South Wales, Australia. (Nepean Hospital ethics approval no: NBM18/805)
Results: Triquetral fractures can be hard to identify with radiography and can be commonly mistaken as lunate fractures.12 Our results indicate that 18.9 per cent of patients required CT imaging to correctly diagnose triquetral fracture.
Conclusion: Where there are ongoing symptoms and a high clinical suspicion of a triquetral fracture, CT may be indicated and, in future practice, may be justified as a first line imaging modality. This study also demonstrates that short arm-wrist immobilsing casts are an effective option for managing triquetral fractures.
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21
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Volar Dislocation of the Fourth and Fifth Carpometacarpal Joint Associated with Hamate Hook Fracture: A Case Report and Literature Review. Case Rep Orthop 2020; 2020:6301692. [PMID: 32206365 PMCID: PMC7079263 DOI: 10.1155/2020/6301692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 11/17/2022] Open
Abstract
We report a case of volar fourth and fifth carpometacarpal (CMC) joint dislocation complicated by a hamate hook fracture. The CMC joint was reduced in a closed fashion and temporally fixed with Kirschner wires. Using intraoperative computed tomography, the displaced fracture of the hamate hook was reduced by open reduction and internal fixation and fixed with a screw. We suggest that this rare injury was caused by the over contraction of the flexor carpi ulnaris and avulsion force from the ligamentous structure around the pisiform, hamate, and metacarpal bones.
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22
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Affiliation(s)
- Henry O'Brien
- Scunthorpe General Hospital, North Lincolnshire, UK henry.o'
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23
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Beekhuizen SR, Quispel CR, Jasper J, Deijkers RLM. The Uncommon Trapezium Fracture: A Case Series. J Wrist Surg 2020; 9:63-70. [PMID: 32025357 PMCID: PMC7000256 DOI: 10.1055/s-0039-1683846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
Background Isolated trapezium fractures are rare and account for only 1 to 5% of all carpal fractures but are still the third most common carpal fracture. Trapezium fractures are hard to detect and easily missed on standard radiographs. Trapezium fractures can be treated conservatively, as well as operatively, the best treatment is still debatable. Damage of the joint surface between the trapezium and the base of the first metacarpal or scaphoid could cause pain and restriction of movements. Therefore, it is important to diagnose and treat the fracture at early stage, so that articular congruence is guaranteed. Case description We present four cases of the uncommon trapezium fracture. All four cases are conservatively treated with good results, there was no need for operative treatment in all the cases. Literature review The literature describes the possibility to use fixation techniques, only when it is not possible to reduce the displaced fracture or the residual articular step-off is too high a fixation technique should be used. Clinical relevance Primarily, we would recommend navicular cast immobilization for 4 to 6 weeks as initial treatment.
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Affiliation(s)
- S. R. Beekhuizen
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - C. R. Quispel
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - J. Jasper
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
| | - R. L. M. Deijkers
- Department of Orthopaedic Surgery, HagaZiekenhuis, The Hague, The Netherlands
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Spencer J, Hunt SL, Zhang C, Walter C, Everist B. Radiographic signs of hook of hamate fracture: evaluation of diagnostic utility. Skeletal Radiol 2019; 48:1891-1898. [PMID: 31134315 DOI: 10.1007/s00256-019-03221-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Hook of hamate fracture, the most common swing-related wrist fracture, is commonly seen in high-level athletes. The fracture is rarely diagnosed on routine wrist radiographs, thus generally requiring CT or MR for diagnosis. Surgical excision has a high success rate, however diagnostic delay contributes to a high complication rate. Radiographic signs of hook of hamate fracture have been published, but uncertainty of the diagnostic accuracy limits application. The purpose of this study is to determine accuracy and interobserver reliability of radiographic signs of hook of hamate. MATERIALS AND METHODS This retrospective case-control study evaluated wrist radiographs of 50 patients, including 24 positive and 26 negative, for hook of hamate fracture, each proven by CT or MR. Five reviewers performed blinded, randomized evaluation of radiographs documenting whether the hook of hamate was normal or fractured, and if fractured, the radiographic signs present (ring sign, ghostly shadow, and diffuse sclerosis) and views that contributed to diagnosis. RESULTS Radiographic signs demonstrated high sensitivity (85%; 95% CI: 77-91), specificity (92%; 95% CI: 86-96), and accuracy (89%; 95% CI: 84-92) with substantial interobserver reliability (k = 0.652). The ring sign was the most sensitive radiographic sign. Diagnosis was most often supported by the oblique view (38%) and rarely the lateral view (15%). CONCLUSIONS Radiographic signs of hook of hamate fracture on routine radiographs can accurately and reliably diagnose hook of hamate fractures. Evaluation for discontinuity of the cortical ring will optimize sensitivity, allowing for timely diagnosis and treatment, and a reduction of complications.
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Affiliation(s)
- Jayden Spencer
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, 66160, USA.
| | - Suzanne L Hunt
- Department of Biostatistics, Kansas University Hospital, 3901 Rainbow Blvd, MS 1026, Kansas City, KS, 66160, USA
| | - Chuanwu Zhang
- Department of Biostatistics, Kansas University Hospital, 3901 Rainbow Blvd, MS 1026, Kansas City, KS, 66160, USA
| | - Carissa Walter
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, 66160, USA
| | - Brian Everist
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, 66160, USA
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Pallaver A, Honigmann P. The Role of Cone-Beam Computed Tomography (CBCT) Scan for Detection and Follow-Up of Traumatic Wrist Pathologies. J Hand Surg Am 2019; 44:1081-1087. [PMID: 31610905 DOI: 10.1016/j.jhsa.2019.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/20/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023]
Abstract
Emergency diagnostics demand fast, easily available, and cost-effective procedures. The higher the accuracy of radiological imaging, the better it supports the surgeon in decision-making for further treatment. Cone-beam computed tomography has been proven to be a reliable tool in diagnosing fractures of the hand and distal forearm. It can be easily installed, has a high spatial resolution, and a potentially lower radiation dose when compared with multislice computed tomography or a series of plain x-rays. This review focuses on the value of conventional radiography, cone-beam computed tomography, and multislice computed tomography for diagnosing traumatic wrist pathologies.
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Affiliation(s)
- Armin Pallaver
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland
| | - Philipp Honigmann
- Hand Surgery, Kantonsspital Baselland, Liestal, Switzerland; Medical Additive Manufacturing Research Group, Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
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26
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Sanderson M, Mohr B, Abraham MK. The Emergent Evaluation and Treatment of Hand and Wrist Injuries: An Update. Emerg Med Clin North Am 2019; 38:61-79. [PMID: 31757255 DOI: 10.1016/j.emc.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Injury patterns of the hand and wrist can be complex and challenging for the emergency physician to diagnose and treat. The ability of the hand to perform delicate maneuvers requires a very intricate interplay of bones, ligaments, and tendons. Unfortunately, due to the omnipresence of the hand, the hand and wrist are commonly injured. These injuries can be debilitating if not treated correctly and can be both time-consuming and fraught with medicolegal risk. This article provides the necessary knowledge to diagnose and treat common hand and wrist injuries encountered in the emergency department.
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Affiliation(s)
- Mark Sanderson
- Department of Emergency Medicine, University of British Columbia, Diamond Health Care Centre 2775 Laurel Street 11th floor, Vancouver, British Columbia V5Z 1M9, Canada
| | - Bruce Mohr
- Department of Emergency Medicine, Whistler Health Care Centre, University of British Columbia, 4380 Lorimer Road, Whistler, British Columbia V8E 1A7, Canada
| | - Michael K Abraham
- Department of Emergency Medicine, University of Maryland School of Medicine, UM Upper Chesapeake Health System, 500 Upper Chesapeake Drive, Bel Air, MD 21014, USA.
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27
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Nonoperative Comminuted Hamate Fracture. J Orthop Sports Phys Ther 2019; 49:557. [PMID: 31258046 DOI: 10.2519/jospt.2019.8514] [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] [Indexed: 02/07/2023]
Abstract
A US Navy sailor was seen at an emergency department after falling on her outstretched hand. A computed tomography (CT) scan demonstrated a comminuted, nondisplaced dorsal hamate fracture. After 8 weeks of cast immobilization, a CT scan revealed no healing and physical therapy was initiated. Following 4 weeks of physical therapy, a third CT scan was performed and demonstrated partial fracture healing without displacement, so physical therapy continued. J Orthop Sports Phys Ther 2019;49(7):557. doi:10.2519/jospt.2019.8514.
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28
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Trapezium fracture: a common clinical mimic of scaphoid fracture. Emerg Radiol 2019; 26:531-540. [PMID: 31250231 DOI: 10.1007/s10140-019-01702-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Fractures of the trapezium are rarely diagnosed on plain radiographs after acute wrist trauma. High-resolution cross-sectional imaging identifies fractures of the trapezium as the most common radiographically occult carpal bone fracture. We review the fracture frequency, mechanisms and patterns of trapezium fractures. METHODS Cone beam CT was performed in patients with suspected radiographically occult radiocarpal fracture following acute injury. The frequency of carpal bone fractures was assessed and compared. RESULTS Ninety-three radiographically occult wrist fractures were identified in 166 patients with acute trauma and negative radiographs. The trapezium was the most frequently fractured carpal bone, making up 20.4% of wrist fractures. Seventy-nine percent of trapezium fractures involved the volar ridge. The scaphoid was the clinically suspected fractured bone at initial assessment in 84% of patients with trapezium fractures. CONCLUSION Fractures of the trapezium in acute wrist trauma are much more common than described in the literature. If initial radiographs are negative, a fracture of the trapezium is more likely to be present than one of the scaphoid, despite high levels of clinical suspicion for scaphoid injuries. Awareness of the types and mechanisms of trapezium fracture is important. Cross-sectional imaging should be considered in all cases of post-traumatic wrist pain with negative radiographs.
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29
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Stress Fracture of the Hamate Hook in a Water Polo Player. Case Rep Orthop 2019; 2019:2483142. [PMID: 31001439 PMCID: PMC6436461 DOI: 10.1155/2019/2483142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/17/2019] [Indexed: 11/17/2022] Open
Abstract
Hamate hook fractures are usually caused by direct trauma while using a tennis racket or a baseball bat. We report stress fracture of the hamate hook in a water polo player without any specific trauma. We consider that the stress fracture occurred via indirect mechanisms through the flexor tendons. Strong ulnar deviation of the wrist during ball release and strong grip on a ball with outstretched fingers, which are unique to water polo, were the likely causes of the stress fracture of the hamate hook.
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30
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Mouzopoulos G, Vlachos C, Karantzalis L, Vlachos K. Fractures of hamate: a clinical overview. Musculoskelet Surg 2019; 103:15-21. [PMID: 29845407 DOI: 10.1007/s12306-018-0543-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
Hamate fractures are exceedingly rare clinical entities. However, the diagnosis and treatment of these injuries are often delayed and can severely handicap the performance of affected laborers or athletes. This review focuses on fractures of the hamate and provides an update on the current consensus as to mechanism, diagnosis, management, and complications after such injuries.
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Affiliation(s)
- G Mouzopoulos
- Orthopaedic Department of Sparti General Hospital, 23100, Sparti Lakonia, Greece.
| | - C Vlachos
- Orthopaedic Department of Sparti General Hospital, 23100, Sparti Lakonia, Greece
| | - L Karantzalis
- Orthopaedic Department of Sparti General Hospital, 23100, Sparti Lakonia, Greece
| | - K Vlachos
- Orthopaedic Department of Sparti General Hospital, 23100, Sparti Lakonia, Greece
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31
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Chang MK, Yap RTJ. Acute ulnar nerve compression associated with pisiform fracture - a case report and literature review. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2019; 6:1-6. [PMID: 32550255 PMCID: PMC6968647 DOI: 10.1080/23320885.2018.1522959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/09/2018] [Indexed: 11/09/2022]
Abstract
We evaluated a case of pisiform fracture with ulnar nerve compression managed with pisiformectomy. At 11 months’ follow-up, the patient regained range of motion of the wrist and grip strength with no subjective loss of function and normal nerve conduction study. We compared other treatment modalities and reviewed their outcomes.
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Affiliation(s)
| | - Robert Tze Jin Yap
- Department of Hand Surgery, Singapore General Hospital, Singapore, Singapore
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32
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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: 2] [Impact Index Per Article: 0.3] [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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33
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Samson D, Jones M, Mahon A. Non-union of the trapezium: rare consequence of a rare injury. J Surg Case Rep 2018; 2018:rjy076. [PMID: 29765589 PMCID: PMC5941166 DOI: 10.1093/jscr/rjy076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 04/17/2018] [Indexed: 11/14/2022] Open
Abstract
Fractures of the trapezium are rare and easily missed. As these injuries are often imperceptible on plain radiographs, diagnosis in the ED setting is challenging. We report a case of an isolated fracture of the trapezium which was picked up as a non-union 5 months after the injury following persistence of symptoms.
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Affiliation(s)
- Deepak Samson
- University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Matthew Jones
- University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - Andrew Mahon
- University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
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34
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Abstract
Carpal bone fractures are common hand fractures that can be complicated by concomitant damage to surrounding structures, chronic comorbidities, or delays in diagnosis. This article provides an overview of wrist anatomy, an expedited review of the athlete's presenting condition, and a systematic approach to the evaluation of the wrist. Recommended treatment plans are based on a review of the literature and an evidence-based approach to imaging studies. It is imperative that sports medicine providers be aware of current literature for carpal bone fractures and collaborate with other medical subspecialties and the athlete to provide recommendations for a safe return to play.
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Affiliation(s)
- Chad Hulsopple
- Department of Family Medicine, Uniformed Services University of Health Sciences, Bethesda, MD
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35
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Athanasiou V, Panagopoulos A, Iliopoulos ID, Vrahnis I, Diamantakis G, Kraniotis P, Tyllianakis M. Intra-articular Fracture of the Distal part of the Triquetrum within the Pisotriquetral Joint: Case Report and Review of Literature. Open Orthop J 2018; 12:84-90. [PMID: 29619121 PMCID: PMC5859460 DOI: 10.2174/1874325001812010084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 02/20/2018] [Accepted: 02/24/2018] [Indexed: 11/22/2022] Open
Abstract
Background Intra-articular fractures of the distal part of the triquetrum within the pisotriquetral joint are uncommon, and can be associated with tears of the dorsal carpal ligaments, pisiform subluxation and/or FCU dislocation. Their diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination including oblique wrist x-rays, computed tomography and MRI scan. These fractures can be delayed diagnosed due to late presentation thus leading to painful nonunion, persistent instability and late pisotriquetral arthritis. Case Report We present a case of a 40-year-old male who complained about ulnarsided wrist pain after a fall on his extended wrist during bicycling. The diagnosis of triquetrum fracture was suspected on clinical examination and confirmed using standard and oblique radiographs and CT scan evaluation. He was immobilized in a short-arm cast for 6 weeks followed by a progressive return to wrist motion and subsequent strengthening for another 5 weeks. He reported complete resolution of pain and excellent wrist motion and function one year after the injury, demonstrating a Mayo score of 100. Conclusion Isolated intra-articular fractures of the triquetrum within the pisotriquetral joint are rare injuries and may constitute a subcategory of body fractures other than the dorsal cortical (chip), main body and volar lip avulsion fractures. Early clinical suspicion and proper imagine can lead to a successful outcome.
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Affiliation(s)
- V Athanasiou
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - A Panagopoulos
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - I D Iliopoulos
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - I Vrahnis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - G Diamantakis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - P Kraniotis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
| | - M Tyllianakis
- Department of Hand Surgery, Orthopaedic Clinic of Patras University Hospital, Patras, Greece
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Gil JA, Goodman AD, Starr A. Coronal Hamate Fracture Associated With Carpometacarpal Dislocations of All of the Fingers: Review of the Literature and Case Report. Hand (N Y) 2017; 12:NP51-NP54. [PMID: 28832201 PMCID: PMC5684916 DOI: 10.1177/1558944716668860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dislocation of all 5 carpometacarpal (CMC) joints of a single hand is a rare injury. METHODS The literature regarding CMC fracture-dislocations was reviewed and a case was presented. RESULTS The relevant literature was consolidated to clinically relevant categories including 'Clinical Presentation and Diagnosis,' 'Management of CMC Fracture Dislocation and Hamate Fractures,' and 'Outcomes.' CONCLUSIONS The mechanism associated with this injury is often high energy that causes multiple simultaneous life- or limb-threatening injuries that could distract the examiner from identifying this injury. The case we present involves an axial dislocation of the carpus that resulted in dorsal dislocations of all CMC joints, dislocation of the hamate-capitate articulation, as well as fractures of the first metacarpal and the hamate.
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Affiliation(s)
- Joseph A. Gil
- Brown University, Warren Alpert Medical School, Department of Orthopaedic Surgery, Providence, RI, USA,Joseph A. Gil, Brown University, Warren Alpert Medical School, Department of Orthopaedic Surgery, 593 Eddy Street, Providence, RI 02903, USA.
| | - Avi D. Goodman
- Brown University, Warren Alpert Medical School, Department of Orthopaedic Surgery, Providence, RI, USA
| | - Adam Starr
- Brown University, Warren Alpert Medical School, Department of Orthopaedic Surgery, Providence, RI, USA
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Martínez-Martínez A, García-Espinosa J. Simultaneous bilateral triquetrum bone fracture. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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38
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Martínez-Martínez A, García-Espinosa J. Fractura bilateral simultánea del piramidal. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:286-288. [DOI: 10.1016/j.recot.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 11/15/2016] [Accepted: 11/16/2016] [Indexed: 11/24/2022] Open
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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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40
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Sato R, Hibino N, Hamada Y, Sairyo K. Ulnolunate Ligament Avulsion Fracture of the Lunate: A Case Report. J Wrist Surg 2017; 6:148-151. [PMID: 28428917 PMCID: PMC5397301 DOI: 10.1055/s-0036-1593359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 08/16/2016] [Indexed: 10/20/2022]
Abstract
Traumatic lunate fractures are very rare and those treatments require an understanding of anatomical features. We present a case of an ulnolunate ligament avulsion fracture of the lunate that was successfully repaired by surgical fixation with open reduction and internal fixation. We believe that restoration of ulnolunate ligament function is important to prevent further deterioration of wrist function after this injury.
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Affiliation(s)
- Ryosuke Sato
- Department of Orthopaedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Naohito Hibino
- Department of Orthopaedic Surgery, Tokushima Prefecture Naruto Hospital, Tokushima, Japan
| | - Yoshitaka Hamada
- Department of Orthopaedic Surgery, Osaka Ekisaikai Hospital, Osaka, Japan
| | - Koichi Sairyo
- Department of Orthopaedic Surgery, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan
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41
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Kadar A, Morsy M, Sur YJ, Laungani AT, Akdag O, Moran SL. The Vascular Anatomy of the Capitate: New Discoveries Using Micro-Computed Tomography Imaging. J Hand Surg Am 2017; 42:78-86. [PMID: 28160904 DOI: 10.1016/j.jhsa.2016.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 12/01/2016] [Accepted: 12/08/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To study the intraosseous 3-dimensional microvasculature of the capitate bone using a novel high-resolution micro-computed tomography (μCT) imaging technology, and to examine the blood supply as it relates to the most common fracture types. METHODS Ten cadaveric wrists were injected with a lead-based contrast agent. The capitates were harvested and imaged using a μCT scanner. The intraosseous vascularity was incorporated into a 3-dimensional image. We measured the vascular pattern as well as the vessels' cross-sectional area, number, and distribution. An average capitate fracture line was calculated using clinical data from 22 patients with capitate fractures. The fracture line was projected on the representative capitate to assess its relation with the nutrient vessels' entry points. RESULTS The capitate is a well-vascularized carpal supplied by dorsal and volar vascular systems that anastomose in 30% of cases. There was no predominance of one vascular system over the other. Most vessels enter the capitate at the distal half and supply the proximal pole in a retrograde fashion. In addition, most specimens (70%) also had at least one vessel entering the proximal pole through the volar capitate ligaments and supplying the proximal pole directly. The average fracture line had an oblique orientation, and 90% of the specimens had a blood vessel entering proximal to that line. CONCLUSIONS This μCT vascular study further verifies that the capitate receives most of its vasculature in a retrograde fashion, but the study also shows that most capitates have vessels supplying the proximal pole directly. These findings might explain why most capitate waist fractures do not progress to proximal pole avascular necrosis. CLINICAL RELEVANCE This study characterizes the microvasculature of the capitate and might shed light on processes involved in bone healing and the etiology of capitate avascular necrosis.
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Affiliation(s)
- Assaf Kadar
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Morsy
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt
| | - Yoo-Joon Sur
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, Catholic University of Korea, Uijeongbu, Republic of Korea
| | | | - Osman Akdag
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Plastic Reconstructive and Aesthetic Surgery, Selcuk University, Konya, Turkey
| | - Steven L Moran
- Division of Plastic Surgery, Mayo Clinic, Rochester, MN.
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42
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Spontaneous flexor tendon rupture secondary to capitate non-union. A case report and review of literature. HAND SURGERY & REHABILITATION 2016; 35:292-295. [PMID: 27781995 DOI: 10.1016/j.hansur.2016.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/10/2016] [Accepted: 05/22/2016] [Indexed: 11/22/2022]
Abstract
Rupture of the flexor digitorum profundus and superficialis tendons of the index finger secondary to non-union of the capitate has not yet been reported to our knowledge. We describe the case of a 48-year-old man with rupture of both flexor tendons of the index finger that occurred 15 years after a capitate fracture. The patient was completely asymptomatic before the rupture. Tendon reconstruction was performed using the palmaris longus. One year after surgery, the patient had acceptable range of motion and was pain-free.
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43
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Mahjoub S, Dunet B, Thoreux P, Masquelet AC. Transverse translunate fracture-dislocation: A rare injury. HAND SURGERY & REHABILITATION 2016; 35:220-224. [PMID: 27740466 DOI: 10.1016/j.hansur.2016.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 01/13/2016] [Accepted: 02/29/2016] [Indexed: 11/18/2022]
Abstract
Perilunate fracture-dislocation is rare. We report the case of a 24-year-old male who fell from his motorcycle and presented with a transverse lunate fracture with perilunate ligament damage. The initial diagnosis based on X-rays was confirmed by CT scan. A dorsal approach was used to obtain good reduction, double screw fixation and ligament reinsertion protected by temporary K-wires. To the best of our knowledge, this is the first case of transverse lunate fracture within perilunate fracture-dislocation. The patient returned to normal activities after 6 months.
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Affiliation(s)
- S Mahjoub
- Service de chirurgie orthopédique et traumatologique, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France; Service de chirurgie orthopédique et traumatologique, hôpital de Libourne, 112, rue de la Marne, 33505 Libourne, France
| | - B Dunet
- Unité membre supérieur, service de chirurgie orthopédique et traumatologique, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France; Service de chirurgie orthopédique et traumatologique, hôpital de Libourne, 112, rue de la Marne, 33505 Libourne, France.
| | - P Thoreux
- Service de chirurgie orthopédique et traumatologique, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
| | - A C Masquelet
- Service de chirurgie orthopédique et traumatologique, hôpital Avicenne, 125, rue de Stalingrad, 93000 Bobigny, France
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Abstract
Ulnar-sided wrist pain can be a challenging entity for the hand surgeon and even more so in the athletic population. The authors present 8 causes of ulnar-sided wrist pain in an athlete (hook of hamate fracture, pisiform fracture, hypothenar hammer syndrome, triangular fibrocartilage complex injuries, ulnocarpal impaction syndrome, lunotriquetral ligament tears, extensor carpi ulnaris tendinitis, subluxation of extensor carpi ulnaris) and their associated imaging and treatment options.
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Affiliation(s)
| | - Ky M Kobayashi
- Colorado Center of Orthopaedic Excellence, 2446 Research Parkway, Suite 200, Colorado Springs, CO 80920, USA
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45
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Kadar A, Morsy M, Sur YJ, Akdag O, Moran SL. Capitate Fractures: A Review of 53 Patients. J Hand Surg Am 2016; 41:e359-e366. [PMID: 27524693 DOI: 10.1016/j.jhsa.2016.07.099] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the demographics, diagnosis, management, and outcomes of capitate fractures in the adult and pediatric population treated in our institution. METHODS We performed a retrospective chart and radiographic review of 53 patients with capitate fractures treated in our institution between 2002 and 2015. Patients' demographic characteristics, mechanism of injury, management including surgery-related data, and outcomes, including complications, were recorded. A radiographic evaluation of the location and pattern of the fracture was performed. RESULTS Capitate fractures were prevalent in young males and older females. Fracture location was variable with 9 different locations; in addition 80% of patients had an associated fracture in the wrist or hand. The most common fracture pattern was the transscaphoid, transcapitate perilunate dislocation. Most diagnoses were made with the aid of advanced imaging. Within this series, there was only 1 case (4%) of fracture nonunion and there were no cases of avascular necrosis of the proximal pole in limited follow-up. Isolated capitate fractures were significantly more common in children. In addition, children had better functional outcomes than adults. CONCLUSIONS This series provides updated information on this rare injury. Nonunion of the capitate, which was previously described as the most common complication, was rare in this cohort. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Assaf Kadar
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN; Orthopedic Division, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Morsy
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt
| | - Yoo-Joon Sur
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Osman Akdag
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN; Department of Plastic Reconstructive and Aesthetic Surgery, Selcuk University, Konya, Turkey
| | - Steven L Moran
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN.
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46
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Read PJ, Morrison WB. Imaging Injuries in Throwing Sports Beyond the Typical Shoulder and Elbow Pathologies. Radiol Clin North Am 2016; 54:857-64. [PMID: 27545424 DOI: 10.1016/j.rcl.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review article describes injuries that occur in the upper extremities of athletes less commonly than those typically discussed with shoulders and elbows. A survey of osseous, musculotendinous, ligamentous, and neurovascular injuries is presented along with associated imaging findings and standard treatment options. This article does not focus on the classic throwing injuries of the shoulder or elbow; the goal is to survey injuries in throwing sports that involve structures away from the glenohumeral, acromioclavicular, or elbow joints. The goal of this article is to introduce readers to these less common injuries, describe their clinical presentations, and characterize their typical imaging appearances.
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Affiliation(s)
- Paul J Read
- Division of Musculoskeletal Radiology and Interventions, Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA.
| | - William B Morrison
- Division of Musculoskeletal Radiology and Interventions, Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA
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47
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Thiebaud PC, Ghazanfari A, Yordanov Y. Fracture du processus unciforme de l’hamatum. ANNALES FRANCAISES DE MEDECINE D URGENCE 2016. [DOI: 10.1007/s13341-016-0651-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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De Nigris G, Falzarano G, Medici A, Mccabe SJ, Predrag G, Meccariello ML, Meccariello L. A rare case of isolated trapezium fracture in motorcycle polytrauma patient in emergency department. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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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; 51:63-5. [PMID: 27071314 DOI: 10.1016/j.jemermed.2015.02.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/18/2015] [Accepted: 02/21/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hook of the hamate fractures are particularly rare carpal fractures with significant morbidity if not diagnosed early. Classically, these fractures occur from localized blunt trauma to the hook of the hamate in racket sports. Common complaints include pain localized in the hypothenar eminence and reduced grip strength. Hook of the hamate fractures have the potential to cause significant injury to the ulnar nerve and artery. CASE REPORT We present the case of a 43-year-old man with hypothenar pain, paresthesias of the fifth finger and ulnar aspect of the fourth finger, and pallor of the fourth and fifth fingers. Using bedside ultrasonography, the patient was found to have a fracture of the hook of the hamate that was causing compression of the ulnar artery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fracture of the hook of the hamate is often not seen on x-ray studies, and fracture fragments can cause compression of adjacent structures, including the ulnar and median nerves and ulnar artery. Bedside ultrasound may be a useful adjunct in the diagnosis of this carpal fracture when standard x-ray studies do not show a fracture and clinical presentation is concerning for the diagnosis.
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Affiliation(s)
- Richard M Maier
- Sparrow Health Systems, Michigan State University Emergency Medicine Residency, Lansing, Michigan
| | - Mary Hughes
- Sparrow Health Systems, Michigan State University Emergency Medicine Residency, Lansing, Michigan
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