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Common Hand Injuries in the Baseball Player. Curr Rev Musculoskelet Med 2022; 16:19-23. [PMID: 36508080 PMCID: PMC9839919 DOI: 10.1007/s12178-022-09812-0] [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: 11/14/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE OF THE REVIEW The list of potential hand and wrist injuries among baseball players is numerous and includes fractures, dislocations, strains, and sprains. The purpose of this review, however, is to highlight injuries to the hand and wrist which are either particularly common or unique to professional baseball players with an emphasis on diagnostic pearls and treatment principles. RECENT FINDINGS For many baseball-related hand and wrist injuries, descriptions of the pathophysiology, diagnosis, and treatment options are based on single institution case series. With the implementation of Major League Baseball's Health and Injury Tracking System, our understanding of the epidemiology of these injuries in professional baseball players has greatly improved. The most common injury requiring operative treatment is a hook of hamate fracture, and recent evidence increasingly supports fracture fragment excision for early pain-free return to sport. Fractures of the proximal phalanges of fingers, thumb phalangeal fractures, and UCL injuries are the most common indication for surgery of the digits. A4 pulley ruptures in pitchers and repetitive trauma to the vasculature of the palm and digits are relatively unique to professional baseball players and are frequently able to be managed non-operatively. While injuries to the hand and wrist are common, the median number of days missed due to such an injury was only 4 days among professional baseball players. Statements and Declarations" for inclusion in the published paper. Please note that submissions that do not include relevant declarations will be returned as incomplete.
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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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Yan YY, Holmes RD, Mallinson PI, Andrews GT, Munk PL, Ouellette HA. Imaging Review of Hockey-Related Upper Extremity Injuries. Semin Musculoskelet Radiol 2022; 26:3-12. [PMID: 35139555 DOI: 10.1055/s-0041-1731422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ice hockey is a fast-paced contact sport with a high incidence of injuries. Upper extremity injury is one of the most common regions of the body to be injured in hockey. This imaging review will equip the radiologist with a knowledge of the more common and severe upper extremity injuries that occur in this sport.
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Affiliation(s)
- Yet Yen Yan
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.,Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - R Davis Holmes
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Paul I Mallinson
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gordon T Andrews
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Peter L Munk
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hugue A Ouellette
- Musculoskeletal Section, Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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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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Abstract
Injuries of the hand and wrist are common in baseball. Because of the unique motions and loads encountered in this sport, physicians treating baseball players may encounter hand and wrist injuries ranging from common to rare. An understanding of these baseball-related injuries must include their pathoanatomy, diagnosis, and treatment options. This knowledge is critical for the general orthopaedic surgeon treating baseball players to allow for timely and appropriate treatment. This article reviews the pathophysiology, diagnosis, and treatment of baseball-related hand and wrist injuries, with a target audience of general orthopeadic surgeons.
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Verhiel SHWL, Knaus WJ, Simeone FJ, Mudgal CS. Carpometacarpal 4/5 Fracture Dislocations: Fracture Morphology and Surgical Treatment. J Hand Microsurg 2020; 12:S21-S27. [PMID: 33335367 PMCID: PMC7735554 DOI: 10.1055/s-0039-1692326] [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: 10/26/2022] Open
Abstract
We conducted a retrospective review of six patients with carpometacarpal (CMC) ⅘ fracture-dislocations managed with ORIF by a single surgeon between October 2006 and August 2017. An open, dorsal approach to the hamate was used with a combination of interfragmentary screw fixation and Kirschner wire reduction in the CMC joints. At a mean of 96 days follow-up (range: 31-265), all patients had recovered wrist motion, excellent grip strength, and complete resolution of pain. There were no complications or reoperations during the postoperative period. Radiographic review showed restoration of anatomy and well-maintained congruity of the CMC joints. Our study has shown favorable outcomes after open reduction and internal fixation of the hamate body fracture with interfragmentary screws, when combined with stabilization of the CMC dislocation with percutaneous Kirschner wires. Fracture morphology does not appear to guide choice for specific hardware (size screw, headed/headless) or use of a washer. This is a level IV, therapeutic study.
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Affiliation(s)
- Svenna H. W. L. Verhiel
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - William J. Knaus
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Frank J. Simeone
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Chaitanya S. Mudgal
- Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Scarborough A, MacFarlane RJ, Mehta N, Smith GD. Ulnar tunnel syndrome: pathoanatomy, clinical features and management. Br J Hosp Med (Lond) 2020; 81:1-9. [PMID: 32990073 DOI: 10.12968/hmed.2020.0298] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ulnar tunnel syndrome is compression of the ulnar nerve at the level of the wrist within Guyon's canal. It is most commonly caused by a ganglion cyst but may also be secondary to fractures, inflammatory conditions, neoplasm, vascular anomalies, aberrant musculature or a combination of these. Assessment should include a detailed history focusing on duration, site and progression of symptoms. The level of compression can be estimated clinically on examination by assessing motor and sensory changes in the hand. Investigations are used to confirm diagnosis or to clarify the underlying cause. X-rays and computed tomography can be used to exclude fractures. Ultrasound is used to diagnose ganglion cysts and vascular anomalies, and can localise the level of compression. Nerve conduction studies can be used to support the diagnosis and look for proximal compression. Mild symptoms can be managed non-operatively. Surgical exploration and decompression is the gold standard treatment for neuro-compressive causes with largely good outcomes.
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Affiliation(s)
- Alexander Scarborough
- Hand Management Unit, Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK
| | - Robert J MacFarlane
- Hand Management Unit, Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK
| | - Nisarg Mehta
- Department of Trauma and Orthopaedic Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Gillian D Smith
- Hand Management Unit, Department of Plastic Surgery, Chelsea and Westminster Hospital, London, UK
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Two-incision Approach for the Open Reduction Internal Fixation of Intra-articular Hamate Body Fractures Using a Cannulated Headless Compression Screw. Tech Hand Up Extrem Surg 2020; 24:187-193. [PMID: 32349098 DOI: 10.1097/bth.0000000000000290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fractures of the hamate are relatively rare and there is a paucity of literature describing their natural history, indications for operative fixation, surgical techniques, and outcomes. Most authors recommend operative fixation of displaced intra-articular coronal hamate body fractures, and a dorsal approach with Kirschner wires has most commonly been recommended to achieve this. In this report, a 2-incision approach to the hamate is presented that facilitates rigid internal fixation of coronal hamate body fractures with a cannulated headless compression screw and minimizes the possibility of iatrogenic injury to critical branches of the ulnar nerve. The authors summarize a series of 2 patients with displaced, intra-articular coronal hamate body fractures of differing severity treated successfully with the proposed approach.
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杨 焕, 王 斌, 李 瑞, 张 荐. [Hollow screw in treatment of basilar part fracture of hamate hook]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:489-492. [PMID: 32291986 PMCID: PMC8171511 DOI: 10.7507/1002-1892.201908114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/03/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook. METHODS Five patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness. RESULTS All the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] ( t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] ( t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case. CONCLUSION For the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.
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Affiliation(s)
- 焕友 杨
- 唐山市第二医院手一科(河北唐山 063000)No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
| | - 斌 王
- 唐山市第二医院手一科(河北唐山 063000)No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
| | - 瑞国 李
- 唐山市第二医院手一科(河北唐山 063000)No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
| | - 荐 张
- 唐山市第二医院手一科(河北唐山 063000)No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
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11
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Abstract
Imaging plays a key role in the evaluation and treatment planning of hand and wrist injuries in athletes. Depending on the suspected injury, a combination of conventional radiographs, computed tomography, magnetic resonance imaging, magnetic resonance arthrography, and/or ultrasound may be indicated. This article reviews the strengths and limitations of these imaging modalities and how they can be utilized in commonly encountered clinical questions.
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Affiliation(s)
| | - B Matthew Howe
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
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12
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Abstract
Ulnar-sided wrist pain is a complex entity to diagnose clinically and frequently requires imaging to help confirm or determine the diagnosis. This article reviews the imaging and the logical imaging pathway of the common causes of ulnar-sided wrist pain, and illustrates various pathologies. It also discusses appropriate imaging modalities for various conditions. The causes of ulnar-sided wrist pain are stratified according to the affected anatomical structures, such as bony, soft tissue or neurovascular aetiologies. This review provides a handy imaging framework for non-radiologist clinicians of the common conditions producing ulnar-sided wrist pain. A linked article (10.12968/hmed.2019.80.8.456) detailing the diagnosis of ulnar-sided wrist pain is included in this issue.
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Affiliation(s)
- Joshua Lauder
- Specialist Trainee in Radiology, Department of Radiology, East Lancashire Teaching Hospitals NHS Trust, Blackburn
| | - Fizan Younis
- Consultant Trauma and Orthopaedic Surgeon, Department of Trauma and Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn
| | - Shah Hm Khan
- Consultant Musculoskeletal Radiologist, Department of Radiology, East Lancashire Teaching Hospitals NHS Trust, Blackburn BB2 3HH, and Honorary Senior Lecturer, University of Central Lancashire, Preston
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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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Takeda S, Tatebe M, Ishii H, Morita A, Wakai K, Hirata H. Computerized tomographic prediction of flexor tendon injuries complicating hamate hook fractures. J Hand Surg Eur Vol 2019; 44:367-371. [PMID: 30674228 DOI: 10.1177/1753193418823503] [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] [Indexed: 02/03/2023]
Abstract
We reviewed computerized axial tomography of 28 patients with hamate hook fractures who had surgical resection of the hook. We analysed the relationship between the fragment height ratio, fragment gap, and intraoperative findings of the tendons. We determined whether parameters in the images can predict complication of tear or disruption of the flexor tendons to the ring or little fingers. Of 28 patients, 16 had fragment height ratios between 50-74; ten among them had worn (eight patients) or ruptured (two patients) flexor tendons. Nine of the ten patients had fragment gaps greater than 2 mm. The remaining 12 patients had fragment height ratios between 75-100 and had intact tendons. We conclude that a fragment height ratio greater than 75 and fragment gap less than 2 mm in computer tomography may rule out tear or disruption of the flexor tendons of the ring and little fingers after hamate hook fractures, and a fragment height ratio between 50-74 with fragment gap greater than 2 mm indicates a high risk of flexor tendon tear or disruption. Level of evidence: IV.
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Affiliation(s)
- Shinsuke Takeda
- 1 Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.,2 Hand and Microsurgery Center, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Masahiro Tatebe
- 1 Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisao Ishii
- 1 Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akimasa Morita
- 3 Department of Orthopaedic Surgery, Suzuka Kaisei Hospital, Suzuka, Mie, Japan
| | - Kenji Wakai
- 4 Department of Preventive Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Hirata
- 1 Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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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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Lamas-Gómez C, Velasco-González L, González-Osuna A, Almenara-Fernández M, Trigo-Lahoz L, Aguilera-Roig X. Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:115-119. [PMID: 30638780 PMCID: PMC6506807 DOI: 10.1016/j.aott.2018.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/25/2018] [Accepted: 12/19/2018] [Indexed: 11/26/2022]
Abstract
Objective The aim of this study was to evaluate the outcomes of open reduction and internal fixation (ORIF) in hamate hook fractures and review the literature on this surgical procedure. Methods We report the outcomes of ORIF of hamate hook fractures in 13 consecutive patients (12 men and 1 woman; mean age: 32 years (range, 22–48 years)). In eight patients (61%) the fracture was associated with ulnar nerve neuritis in Guyon's canal. We assessed the following clinical data: age, sex, mechanism of injury, side of the injured hand and associated lesions, fracture classification, average time from injury to correct diagnosis, surgical technique, complications, and length of follow-up. All patients underwent radiological imaging, including standard radiographs in two planes (anteroposterior and lateral projections), and a CT study. Functional outcomes evaluated were pain, range of motion, grip strength, Disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score. Results The mean follow-up was 36 months (range, 12–144 months). All 13 cases were treated with ORIF of the hook of the hamate. Mean VAS pain score was 5 preoperatively (4–9) and 1 (0–2) postoperatively. All patients returned to pre-injury level and only one patient felt pain on activity. Preoperative modified Mayo wrist score was 51 and the postoperative value was 94. All outcomes scores improved significantly from preoperative values. The patients who participated in sports postoperatively were able to do so at or near pre-injury levels. Postoperative average range of wrist motion was 76° in extension, 71° in flexion, 14° in ulnar deviation, and 21° in radial deviation. Mean grip strength in the hand with the hook fracture was 58 kg compared with 53 Kg in the unaffected hand. All patients returned to their pre-injury level of functioning after 10–12 weeks and there were no complications. Analysis of grip strength revealed values comparable with the unaffected hand. Conclusion ORIF of hamate hook fractures is a safe and effective technique to restore normal grip strength and return to pre-injury level. In cases of ulnar nerve neuritis, neurolysis of the deep palmar branch is mandatory. Level of evidence Level IV, Therapeutic study.
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Abstract
Injuries to the hands and wrist are common in athletes. Injuries include acute fractures, dislocations, ligamentous, and tendon injuries, as well as more chronic injuries such as sprains and strains. Complications in the treatment of sports injuries of the hand and wrist may be divided into 2 categories: incorrect or delayed diagnosis and iatrogenic injury related to treatment. This article highlights common sports injuries of the hand and wrist and their complications, and includes tips for successful management.
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Affiliation(s)
- Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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Concomitant hook of hamate fractures in patients with scaphoid fracture: more common than you might think. Skeletal Radiol 2018; 47:505-510. [PMID: 29143872 PMCID: PMC5814468 DOI: 10.1007/s00256-017-2814-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 10/21/2017] [Accepted: 10/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The scaphoid is the most commonly fractured carpal bone. The presence of a concomitant hook of hamate fracture is of particular relevance given that it is often occult on routine wrist/scaphoid radiographs and that hook of hamate fractures are prone to symptomatic non-union, resulting in chronic ulnar wrist pain. Prompt diagnosis and immobilisation/fixation may minimise such complications. Our study is aimed at assessing the frequency of concomitant hook of hamate fractures in patients with scaphoid fractures. METHODS Hook of hamate fracture is often occult on wrist/scaphoid radiographs. Hence, we identified all 2,568 CT and MRI studies performed to investigate scaphoid fracture at our institution from April 2005 to March 2016. Three hundred and twelve out of 2,568 cases were confirmed to have a scaphoid fracture. Images were then retrospectively reviewed by a Consultant Musculoskeletal Radiologist and Musculoskeletal Radiologist Trainee to assess for the presence of concomitant hook of hamate fracture and, if present, whether this was identified on initial reporting. RESULTS Concomitant hook of hamate fracture was identified in 10.3% of cases (32 out of 312, 30 on CT, 2 on MRI); most were minimally/non-displaced. Sixty percent of fractures identified on CT were missed on the initial review (18 out of 30). Both cases identified on MRI had been initially reported. CONCLUSION Scaphoid fracture is associated with higher than expected rates of concomitant hook of hamate fracture. Given the potential morbidity associated with hook of hamate fracture, this should be considered a review area when investigating scaphoid injury. These fractures are often minimally displaced, hence easily overlooked on CT. MRI may therefore be superior when investigating radiographically occult scaphoid fractures.
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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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Abstract
Determining the etiology of ulnar-sided wrist pain is often challenging. The condition may be acute or chronic, and differential diagnoses include injuries to the ulnar carpal bones, ligament tears, tendinitis, vascular conditions, osteoarthritis and systemic arthritis, and ulnar nerve compression. An anatomically based, methodical physical examination coupled with provocative maneuvers, including piano key, ulnar impaction, shuck, foveal stress, and extensor carpi ulnaris synergy tests, further defines the differential diagnosis. Diagnostic imaging used in the evaluation of ulnar-sided wrist pain includes plain radiographs and MRI with or without arthrography. Wrist arthroscopy is becoming increasingly important in the diagnosis and management of ulnar-sided intra-articular wrist pathology.
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22
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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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23
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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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24
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How Kit N, Malherbe M, Hulet C. Hamate hook stress fracture in a professional bowler: Case report of an unusual causal sport. HAND SURGERY & REHABILITATION 2017; 36:62-65. [PMID: 28137446 DOI: 10.1016/j.hansur.2016.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/06/2016] [Accepted: 06/13/2016] [Indexed: 11/27/2022]
Abstract
Stress fracture of the hook of the hamate is uncommon and is usually seen in sports involving a club, racquet or bat (i.e., golf, tennis or baseball). It is caused by direct blunt trauma. We report an unusual case of stress fracture with non-union in a 23-year-old professional bowler, probably caused by endogenous constraints, 1 year after the start of symptoms. Treatment consisted of surgical resection of the hook of the hamate. Multimodal imaging of this fracture is reviewed.
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Affiliation(s)
- N How Kit
- CHU de Caen, Service de radiologie générale, avenue de la Côte-de-Nacre, 14003 Caen, France
| | - M Malherbe
- CHU de Caen, Service de chirurgie orthopédique, Inserm U1075 COMETE, avenue de la Côte-de-Nacre, 14003 Caen, France.
| | - C Hulet
- CHU de Caen, Service de chirurgie orthopédique, Inserm U1075 COMETE, avenue de la Côte-de-Nacre, 14003 Caen, France
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Abstract
A thorough understanding of the swing phases and mechanisms of injury in golf allows accurate diagnosis, treatment, and future prevention of injuries. Recommended initial treatment starts with cessation of practice to rest the wrist, a splint or orthotic brace, and nonsteroidal antiinflammatory drug medication with corticosteroid injection and swing modification. Pisiform excision is the best treatment of the most severe chronic cases of pisiform ligament complex syndrome. Delayed diagnosis of hook of hamate fracture may lead to complications, including flexor tendon rupture. Prompt surgical resection is recommended to hasten return to sport and to prevent further complications.
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Affiliation(s)
- Sang-Hyun Woo
- W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-Gu, Daegu 42642, Korea
| | - Young-Keun Lee
- Department of Orthopaedic Surgery, Chonbuk National University Hospital, 93, Changpo-gil, Deokjin-gu, Jeonju, Jeollabuk-do 54896, Korea.
| | - Jong-Min Kim
- W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-Gu, Daegu 42642, Korea
| | - Ho-Jun Cheon
- W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-Gu, Daegu 42642, Korea
| | - William H J Chung
- Comprehensive Hand Center, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building 14 G200, Ann Arbor, MI 48109, USA
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26
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Cockenpot E, Lefebvre G, Demondion X, Chantelot C, Cotten A. Imaging of Sports-related Hand and Wrist Injuries: Sports Imaging Series. Radiology 2016; 279:674-92. [PMID: 27183404 DOI: 10.1148/radiol.2016150995] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hand and wrist injuries are common occurrences in amateur and professional sports and many of them are sport-specific. These can be divided into two categories: traumatic injuries and overuse injuries. The aim of this article is to review the most common hand and wrist sports-related lesions. Acute wrist injuries are predominantly bone fractures, such as those of the scaphoid, hamate hook, and ulnar styloid. Ligament lesions are more challenging for radiologists and may lead to carpal instability if undiagnosed. Overuse wrist injuries are mainly represented by tendinous disorders, with De Quervain syndrome and extensor carpi ulnaris tendon disorders being the most common among them; however, there are other possible disorders such as impaction syndromes, stress fractures, and neurovascular lesions. Finally, finger lesions, including closed-tendon injuries (mallet and boutonniere injuries, jersey finger, and boxer's knuckle), flexor pulley injuries, and skier's thumb, should also be detected. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Eric Cockenpot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Guillaume Lefebvre
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Xavier Demondion
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Christophe Chantelot
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
| | - Anne Cotten
- From the Department of Radiology and Musculoskeletal Imaging, CHRU Lille Centre de Consultations et d'Imagerie de l'Appareil Locomoteur, Rue du Professeur Emile Laine, 59037 Lille, France
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27
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O'Connor PJ, Campbell R, Bharath AK, Campbell D, Hawkes R, Robinson P. Pictorial review of wrist injuries in the elite golfer. Br J Sports Med 2016; 50:1053-63. [DOI: 10.1136/bjsports-2016-096149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 11/04/2022]
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28
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Kim JH, Kwon SS, Moon SJ, Choe JS, Kwak HI, Lee SY, Le HJ, Kim JY. Reliability of classification of ring and little finger carpometacarpal joint fracture subluxations: a comparison between two-dimensional computed tomography and three-dimensional computed tomography classifications. J Hand Surg Eur Vol 2016; 41:448-52. [PMID: 26329885 DOI: 10.1177/1753193415602589] [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] [Received: 11/26/2014] [Accepted: 06/09/2015] [Indexed: 02/03/2023]
Abstract
The aims of this study were to develop a classification for ring and little finger carpometacarpal joint fracture subluxations based on three-dimensional computed tomography images and evaluate the inter- and intraobserver reliability of the three-dimensional computed tomography classification. A retrospective review was performed of 30 cases of ring and little finger carpometacarpal joint fracture subluxations from 2005 to 2013. We classified ring and little finger carpometacarpal joint fracture subluxations into three types based on three-dimensional computed tomography images. An orthopaedic surgeon with 2 years of experience, a consultant hand surgeon with 8 years of experience, and a consultant radiologist with 9 years of experience, who were completely blind to the treatment algorithm, evaluated 30 cases twice at a 2-week interval using our new classification based on three-dimensional computed tomography images and the other classification based on two-dimensional computed tomography images. Our three-dimensional computed tomography classification showed almost perfect interobserver and intraobserver reliability and resulted in a better level of agreement than two-dimensional computed tomography classification.
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Affiliation(s)
- J H Kim
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
| | - S-S Kwon
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seoul, Korea
| | - S J Moon
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
| | - J S Choe
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
| | - H I Kwak
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
| | - S Y Lee
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital
| | - H J Le
- Department of Radiology, Konkuk University School of Medicine
| | - J Y Kim
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
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29
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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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30
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Tan HK, Chew N, Chew KTL, Peh WCG. Clinics in diagnostic imaging (156). Golf-induced hamate hook fracture. Singapore Med J 2016; 55:517-20; quiz 521. [PMID: 25631891 DOI: 10.11622/smedj.2014133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain's disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.
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Affiliation(s)
| | | | | | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Alexandra Health, 90 Yishun Central, Singapore 768828.
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31
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Pan T, Lögters TT, Windolf J, Kaufmann R. Uncommon carpal fractures. Eur J Trauma Emerg Surg 2015; 42:15-27. [PMID: 26676306 DOI: 10.1007/s00068-015-0618-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
Fractures of the hand are frequently encountered with injuries to the phalanges and metacarpals comprising the vast majority. Fractures of the carpal bones excluding the scaphoid, however, are fairly uncommon. Despite the rarity of fractures of the remaining seven carpal bones, they can cause a disproportionate amount of morbidity from missed diagnosis due to their subtlety as well as their frequent association with significant ligamentous disruption or even other carpal bone fractures. Delayed diagnosis can result in inadequate fracture care, which places the wrist at risk of disabling sequelae. This review focuses on the current concepts of pathophysiology, diagnosis, and treatment of carpal fractures other than the scaphoid.
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Affiliation(s)
- T Pan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, USA.
| | - T T Lögters
- Department of Trauma and Hand Surgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Windolf
- Department of Trauma and Hand Surgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - R Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, USA
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33
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34
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Abstract
This article reviews the most common complications associated with the management of carpal fractures. Discussion focuses on the recognition of commonly "missed" fractures and fracture patterns and the negative sequelae that can result from these delayed diagnoses. The pitfalls of conservative treatment of specific carpal fractures are reviewed, and the most common complications resulting from the operative management of carpal injuries are described.
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Affiliation(s)
- R Glenn Gaston
- OrthoCarolina, 1915 Randolph Road, Charlotte, NC 28207, USA.
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35
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Klausmeyer MA, Mudgal CS. Hook of hamate fractures. J Hand Surg Am 2013; 38:2457-60; quiz 2460. [PMID: 23891177 DOI: 10.1016/j.jhsa.2013.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/01/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Melissa A Klausmeyer
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA
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36
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Scheufler O, Kamusella P, Tadda L, Radmer S, Russo SG, Andresen R. HIGH INCIDENCE OF HAMATE HOOK FRACTURES IN UNDERWATER RUGBY PLAYERS: DIAGNOSTIC AND THERAPEUTIC IMPLICATIONS. ACTA ACUST UNITED AC 2013; 18:357-63. [DOI: 10.1142/s0218810413500391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hamate hook fractures are rare injuries but appear to occur frequently in underwater rugby, the reason for which was investigated in this study. High-level underwater rugby players with hook fractures diagnosed during a five-year interval (2005–2010) were studied retrospectively. Medical data on these patients were reviewed for information on the mechanism of injury, type of fracture, radiological imaging, treatment, and outcome. In ten patients, hook fractures of the leading hand were confirmed by computed tomography, all of which were associated with specific injuries during underwater rugby games. Conservative treatment resulted in delayed healing or non-union, wherefore fragment excision and open reduction and internal fixation was performed in ten and five patients, respectively, while two patients declined surgery. After surgery, all patients were able to play underwater rugby again. In underwater rugby, hook fractures occur frequently due to high and repeated forces applied to the leading hand during games.
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Affiliation(s)
| | - Peter Kamusella
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide — Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Germany
| | - Lukas Tadda
- Department of Pulmonology, Klinikum am Bruderwald, Bamberg, Germany
| | | | - Sebastian G. Russo
- Department of Anesthesiology, Emergency and Intensive Care Medicine, Göttingen University Hospital, Germany
| | - Reimer Andresen
- Institute for Diagnostic and Interventional Radiology/Neuroradiology, Westküstenklinikum Heide — Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Germany
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37
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Abstract
Osseous injuries to the ulnar aspect of the carpus are increasing in frequency because of greater participation in sporting activities. Hamate body fractures are subdivided into coronal, sagittal oblique, proximal pole, and medial tuberosity fractures. Successful treatment of coronal fractures requires identification and treatment of associated disruption or instability of the ulnar 2 carpometacarpal joints. Displaced hamate hook fractures are optimally treated with early excision to avoid sequelae such as flexor tendon and nerve injury, and to allow early return to activity. Undisplaced pisiform fractures are managed nonoperatively, whereas displaced fractures and nonunions are treated by simple excision.
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38
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Combined intraarticular fracture of the body and the hook of hamate: an unusual injury pattern. J Hand Microsurg 2012; 5:92-5. [PMID: 24426686 DOI: 10.1007/s12593-012-0070-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 05/23/2012] [Indexed: 10/28/2022] Open
Abstract
Isolated fractures of the carpal hamate are rare. We describe a case of 28-year-old male patient who sustained a rare pattern of wrist injury: combined intraarticular fracture of the body and the hook of hamate in the non-dominant left hand. The patient was treated with percutaneous pinning of the fracture of hamate body.
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39
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Huang HC, Fu CY, Hsieh CH, Wang YC, Wu SC, Chen RJ, Huang JC. Lodox/Statscan facilitates the early detection of commonly overlooked extracranial injuries in patients with traumatic brain injury. Eur J Trauma Emerg Surg 2012; 38:319-26. [PMID: 26815965 DOI: 10.1007/s00068-012-0176-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Accepted: 12/31/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a common diagnosis in the emergency department. Brain computed tomography (CT) has become a standard diagnostic tool with which to examine TBI patients. Conventional X-rays are ineffective for the evaluation of torso or extremity injuries. In the current study, we attempted to establish a diagnostic modality to evaluate systemically initially unconscious patients in the emergency department with a rapid screening technique characterized by sufficient information, low cost and low radiation exposure. MATERIALS AND METHODS From January 2008 to December 2009, patients with diminished level of consciousness received the Lodox/Statscan for evaluation of extracranial injuries were enrolled in this study. The accuracy of this diagnostic modality in detecting torso or extremity injuries in initially unconscious patients was analyzed by comparing the initial diagnosis (by the Lodox/Statscan) with the final diagnosis (confirmed by torso CT scan or after two weeks of follow-up). RESULTS There were 1,210 patients with TBI whose extracranial injuries were evaluated by the Lodox/Statscan. After excluding intra-abdominal injuries, the overall sensitivity rates of the Lodox/Statscan in diagnosing torso injuries and extremity injuries were 89.7% and 90.2%, respectively. No long bone fracture was missed by the Lodox/Statscan. The sensitivity and specificity of the Lodox/Statscan in diagnosing long bone fractures were both 100%. Most patients with torso injuries that were missed by the Lodox/Statscan could be managed conservatively without further treatment or complications. All of the missed extremity injuries were distal bone fractures. CONCLUSION The Lodox/Statscan can provide benefits for surveying extracranial injuries in patients with diminished level of consciousness. The Lodox/Statscan also emits a notably low dose of radiation and appears to be a relatively inexpensive adjunct to screen torso or extremity injuries in TBI patients.
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Affiliation(s)
- H-C Huang
- Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
- Trauma and Emergency Surgery Department, Taipei Medical University, Wan Fang Hospital, No. 111, Section 3, Hsing Long Rd, Taipei, 116, Taiwan, ROC.
| | - C-Y Fu
- Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
- Trauma and Emergency Surgery Department, Taipei Medical University, Wan Fang Hospital, No. 111, Section 3, Hsing Long Rd, Taipei, 116, Taiwan, ROC.
| | - C-H Hsieh
- Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
| | - Y-C Wang
- Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
- Trauma and Emergency Surgery Department, Taipei Medical University, Wan Fang Hospital, No. 111, Section 3, Hsing Long Rd, Taipei, 116, Taiwan, ROC.
| | - S-C Wu
- Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
| | - R-J Chen
- Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
- Trauma and Emergency Surgery Department, Taipei Medical University, Wan Fang Hospital, No. 111, Section 3, Hsing Long Rd, Taipei, 116, Taiwan, ROC.
| | - J-C Huang
- Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, Taiwan, ROC.
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Fractura aislada del cuerpo del hueso ganchoso. A propósito de un caso. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2011.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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41
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Torres J, Abat F, Monteiro E, Gelber P. Isolated fracture of the body of the hamate bone. About a case. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/s1988-8856(11)70321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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42
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Abstract
The anatomy of the hand is complex, which allows for the dexterity, strength, and adaptability of the most functional aspect of the musculoskeletal system. The evaluation and management of injuries to this area can be time consuming and pose a significant medicolegal risk to the emergency physician. Improperly diagnosed and managed injuries can lead to chronic pain, inability to perform activities of daily living, and even seemingly minor injuries can lead to missed work causing a significant cost to the individual and society. The purpose of this article is to review injuries to the hand and wrist and discuss diagnostic studies and treatment plans that the emergency physician can use to treat patients effectively and minimize their exposure to risk.
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43
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44
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Borse VH, Hahnel J, Faraj A. Lessons to be learned from a missed case of Hamate fracture: a case report. J Orthop Surg Res 2010; 5:64. [PMID: 20799974 PMCID: PMC2936889 DOI: 10.1186/1749-799x-5-64] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 08/27/2010] [Indexed: 11/10/2022] Open
Abstract
Introduction We report the case of a missed fracture through the body of the hamate bone, only detected on a later, mistakenly taken 30° oblique x-ray view. This case highlights some of the problems encountered with traditional x-ray views, and the need to consider oblique views as either standard procedure or as an adjunct where clinical suspicion remains high even in the presence of normal x-rays. Case presentation A healthy 26-year-old Caucasian male fell whilst jogging, suffering a low velocity injury to his right hand. Initial accident and emergency examination and x-rays failed to demonstrate a fracture. At clinic, anteroposterior and carpal tunnel radiographs showed no fracture, however a mistakenly taken oblique x-ray revealed a displaced hamate body fracture. Conclusion The authors believe that where a hamate fracture is suspected, an oblique x-ray view should be considered as part of the initial diagnostic investigations. Furthermore an oblique x-ray view is of particular use when clinical suspicion for hamate fracture remains high in the light of otherwise normal x-rays.
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Affiliation(s)
- Vishal H Borse
- Vishal Borse, Room 346, Institute of Medical & Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK.
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Abstract
Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.
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Affiliation(s)
- Steven Papp
- Department of Orthopaedic Surgery, University of Ottawa, Ottawa Civic Hospital, Ottawa, Ontario, Canada K1Y 4E9.
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Abstract
A wide range of hand and wrist injuries occur in today's recreational and elite athletes and account for 3% to 9% of all sports injuries. The onus is on the physician to discriminate between injuries that can be managed with an early return to sport, and those injuries that place the athlete at risk of further injury if they are not managed aggressively from the outset. The physician and the athlete must understand the balance between safe, early return to sport, and prompt surgical treatment that prevents late disability.
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Affiliation(s)
- Jeffrey Marchessault
- Department of Orthopaedic Surgery, Allegheny General Hospital, 1307 Federal Street, 2nd Floor, Pittsburgh, PA 15212, USA.
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Scheufler O, Radmer S, Bogusch G, Andresen R. Minimal Invasive Fixation of Hamate Hook Fractures Through a Dorsal Percutaneous Approach Using a Mini Compression Screw: An Experimental Feasibility Study. Eur J Trauma Emerg Surg 2008; 35:397-402. [DOI: 10.1007/s00068-008-8112-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
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48
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Abstract
Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.
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Affiliation(s)
- Steven Papp
- Department of Orthopaedic Surgery, University of Ottawa, Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9.
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Andresen R, Radmer S, Scheufler O, Adam C, Bogusch G. Optimierung von konventionellen Röntgenaufnahmen zur Erkennung von Hamulus ossis hamati Frakturen. ACTA ACUST UNITED AC 2006; 56:59-65. [PMID: 16733997 DOI: 10.1016/j.rontge.2005.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Fractures of the hook of the hamate are a rare event. The fracture cannot always be detected clinically and standard radiographs do not always provide an overlap-free image of the hook of the hamate, so that fractures can easily be overlooked. The objective of the present study was to examine if the sensitivity of detecting hamulus ossis hamati fractures can further be improved by a modified conventional radiographic projection. After dissection of the hook of the hamate on 10 cadaver hands, a fracture was produced close to the base using a surgical chisel. Conventional radiographs were then performed in four different projections (dorso-palmar, lateral, carpal-tunnel and oblique view). The oblique view was obtained in a 45 degrees supination position, slight extension and radial duction, with the tube tilted from distal to proximal by 30 degrees. An axial spiral CT was used as a reference for detection of the fracture. The highest sensitivity of the conventional radiographs, with 8/10 identified fractures (80%), was achieved by the oblique view. The carpal-tunnel view with 4/10 (40%) and the dorso-palmar projection with 3/10 (30%) were much lower. All fractures were missed in the lateral projection. If all of the conventional radiographic projections are taken into account, the sensitivity is increased to 90%. All of the fractures were reliably detected in the axial CT-image. If a hamulus ossis hamati fracture is suspected clinically, in addition to the dorso-palmar and carpal-tunnel view, the special oblique view described here should be performed as a third projection plane, while the lateral view can be dispensed with. However, even if all projections are taken into account, a negative finding in the conventional radiographic imaging does not exclude a fracture with absolute certainty. In such cases, a CT or MRI should be performed to exclude a fracture.
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Affiliation(s)
- Reimer Andresen
- Abteilung für Bildgebende Diagnostik und Interventionelle Radiologie, KMG Klinikum Güstrow, Akademisches Lehrkrankenhaus der Universität Rostock.
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Chow JCY, Weiss MA, Gu Y. Anatomic variations of the hook of hamate and the relationship to carpal tunnel syndrome. J Hand Surg Am 2005; 30:1242-7. [PMID: 16344183 DOI: 10.1016/j.jhsa.2005.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2002] [Revised: 05/23/2005] [Accepted: 05/30/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the incidence of anatomic variations of the hook of hamate and to evaluate its association with the development of carpal tunnel syndrome (CTS). METHODS Radiographs of 3,218 hands (2,070 patients) were evaluated. This group included 2,866 hands diagnosed with CTS and 352 hands without the diagnosis of CTS. Using the carpal tunnel view variations of the hook of hamate were identified. Variants were classified based on appearance and measurements. Patients having variant hooks of hamate who were diagnosed with CTS then were compared with patients with variant hooks of hamate who had no evidence of CTS. Endoscopic carpal tunnel release using the Chow technique was performed on all patients with CTS who had a known variation of the hook of hamate without difficulty or complication. RESULTS Variations of the hook of hamate were found in 96 hands: 42, bipartite hook; 50, hypoplastic hook; and 4, aplastic hook. Ninety-three hands with variant hooks of hamate were diagnosed with CTS. The remaining 3 hands identified with variants had no evidence of CTS. After comparing the 2 groups, we found that the incidence of a variant hook of hamate in the group with CTS was significantly greater than the incidence of variations in the group without CTS. CONCLUSIONS Three variations of the hook of hamate were identified with radiographic evaluation using the carpal tunnel view. Variations are more prevalent than once thought. There was a significant increase in the incidence of variation in the hook of hamate in the group with CTS compared with the group without CTS.
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Affiliation(s)
- James C Y Chow
- Orthopaedic Center of Southern Illinois, Mount Vernon, IL 62864, USA.
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