Three-dimensional architecture of intraosseous vascular anatomy of the hamate: a micro-computed tomography study / 北京大学学报(医学版)

OBJECTIVE@#To obtain three-dimensional intraosseous artery of the hamate and to provide the vascular anatomy basis of hamate fracture fixation.@*METHODS@#PbO (lead monoxide, Sinopharm Chemical Reagent Beijing Co. Ltd) was ground into particles less than 40 μm and suspended in turpentine oil (Chemical Reagent Beijing Co. Ltd) at ratios of 1 g : 1.5 mL, 1 g : 1 mL and 1 g : 0.5 mL. Three specimens were investigated. Brachial arteries were cannulated and perfused with lead-based contrast agent. Hamates were harvested and scanned using micro-computed tomography (microCT). The acquisition protocols were as follows: CT scan setup: total rotation [Degrees], 360; rotation steps, 360; X-ray detector setup: transaxial, 2048; axial, 2048; exposure time, 1 500 ms, Binning, 1; system magnification: high-med. X-ray tube setup: 80 kV, 500 mA current. The down-sampling factor used in the reconstruction was 2. The effective voxel size of the final image was 27.30 μm. The three-dimensional model of the hamate was generated and the distribution and pattern of vessels were evaluated.@*RESULTS@#There were abundant extraosseous vessels around the hamate. They were mainly running in the tendons and ligaments around the hamate. Four vascular zones were identified on the hamate surface. They were on the palmar platform of the hamate body, on the dorsal side, on the ulnar side and on the tip of hamulus, namely. There were anastomoses among 4 vascular zones. We did not observe any vessels penetrating through the articular cartilage. The extraosseous vessels of the vascular zones gave a number of intraosseous branches into the hamate. The hamate body received intraosseous blood supply from the dorsal, palmar and ulnar while the hamulus from the palmar, ulnar and hamulus tip. There were some intraosseous branches anastomosing with each other.@*CONCLUSION@#The extraosseous and intraosseous vessels of the hamate were more than what used to be considered. The hamate body and hamulus received blood supply from multiple directions and arteries anastomosed extensively both outside and inside the hamate, making it possible that the intraosseous perfusion survived after fracture. It is likely that the nonunion after the hamate fracture is not caused by the vascular damage but the malalignment of the fragments.

Relationship Between Electrodiagnosis and Various Ultrasonographic Findings for Diagnosis of Carpal Tunnel Syndrome

OBJECTIVE: To investigate the relationship between electrodiagnosis and various ultrasonographic findings of carpal tunnel syndrome (CTS) and propose the ultrasonographic standard that has closest consistency with the electrodiagnosis. METHODS: Ultrasonography was performed on 50 female patients (65 cases) previously diagnosed with CTS and 20 normal female volunteers (40 cases). Ultrasonography parameters were as follows: cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the levels of hamate bone, pisiform bone, and lunate bone; anteroposterior diameter (AP diameter) of the median nerve in the carpal tunnel; wrist to forearm ratio (WFR) of median nerve area at the distal wrist crease and 12 cm proximal to distal wrist crease; and compression ratio (CR) of the median nerve. Independent t-test was performed to compare the ultrasonographic findings between patient and control groups. Significant ultrasonographic findings were compared with the electrodiagnosis results and a kappa coefficient was used to determine the correlation. RESULTS: CSA and FR of median nerve at the hamate bone level, CSA of median nerve at pisiform bone level, AP diameter of median nerve within the carpal tunnel, CSA of median nerve at the distal wrist crease and WFR showed significant differences between patient and control groups. WFR showed highest concordance with electrodiagnosis (κ=0.71, p<0.001). CONCLUSION: These findings suggested the applicability of ultrasonography, especially WFR, as a useful adjunctive tool for diagnosis of CTS.

Clinical Results of Excision of Hamate Hook in the Baseball Players with Hamate Hook Nonunion

PURPOSE: The purpose of this study is to report the clinical results of excision of the hamate hook in baseball players with hamate hook nonunion. MATERIALS AND METHODS: This study included 10 baseball players treated with excision of the hamate hook. Among 10 players, there were 3 professional players and 7 amateur players. The clinical outcomes were evaluated using the visual analog scale (VAS) pain score, exercise performance score, and grip power. We also checked complications and time to return to the game. RESULTS: At final follow-up, the average VAS score was 0.4 points and the average performance score was 9.0 points. The grip power was recovered to 96.7% of the opposite hand at final follow-up. Significant improvement in pain and grip power was observed after surgery. The average time to return to the game was 11.8 weeks. There was one case of postoperative ulnar nerve neuropathy, which was completely resolved within 12 weeks after surgery. CONCLUSION: We think that excision of the hamate hook is an effective treatment to enable early return to the game without loss of grip strength in the baseball player with nonunion of the hamate hook.

Hemi-hamate arthroplasty for unstable dorsal proximal interphalangeal joint fracture dislocation of the fingers

To assess restoration of finger functions after hemi-hamate reconstruction. Experimental / Analytic study. This study was carried out at two different centres at Jinnah Hospital, Lahore and King Khalid Hospital, Najran KSA from between 2010 and 2013. We performed hemi-hamate autograft arthroplasty in 20 patients age 16-45 years. All were having comminuted metaphyseal fracture of volar surface of middle phalynx involving more than 50% [55%-90% average 70%] of articular surface with dorsally displaced unstable proximal interphalyngeal joint. Functional outcome was assessed by grip strength, proximal interphalyngeal joint, distal interphalyngeal joint range of motion and residual pain and patient's satisfaction. At the end of average 24.4 months follow-up mean active range of motion for proximal interphalyngeal joint was 62 °[40°- 90°], distal interphalyngeal joint was 54°[40°-65°] and flexion contracture was 150[00-35°]. Grip strength was achieved upto 95% [50%-95%] of opposite normal hand. Almost all patients were satisfied with functional outcome and appearance of the finger. We had not come across donor site morbidity, graft resorption, avascular necrosis, subluxation/dislocation, coronal/sagittal instability, infections except 4 patients, one scar tenderness, one ulnar digital nerve paresthesia and 2 with early osteoarthritic changes. Non-vascularized hemi-hamate autogarft is a good treatment option for comminuted proximal interphalyngeal fracture dislocation having more than 50% volar lip involvement, resulting in satisfactory functional outcome as compared to other surgical treatments. We recommend it in patients of active age group

Staple fixation for the treatment of hamate metacarpal joint injury / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effcacy of the staple fixation for the treatment of hamate metacarpal joint injury.</p><p><b>METHODS</b>From May 2009 to November 2012,16 patients with hamate metacarpal joint injury were treated with staple fixation including 10 males and 6 females with an average age of 33.6 years old ranging from 21 to 57 years. Among them, 11 cases were on the fourth or fifth metacarpal base dislocation without fractures, 5 cases were the fourth or fifth metacarpal base dislocation with avulsion fractures of the back of hamatum. Regular X-ray review was used to observe the fracture healing, joint replacement and position of staple fixation. The function of carpometacarpal joint and metacarpophalangeal joint were evaluated according to ASIA (TAM) system evaluation method.</p><p><b>RESULTS</b>All incision were healed well with no infection. All patients were followed up from 16 to 24 months with an average of (10.0 +/- 2.7) months. No dislocation recurred, the position of internal fixator was good,no broken nail and screw withdrawal were occurred. Five patients with avulsion fracture of the back of hamatum achieved bone healing. The function of carpometacarpal joint and metacarpophalangeal was excellent in 10 cases,good in 5 cases, moderate in 1 case.</p><p><b>CONCLUSION</b>The application of the staple for the treatment of hamatometacarpal joint injury has the advantages of simple operation, small trauma, reliable fixation, early postoperative function exercise and other advantages, which is the ideal operation mode for hamatometacarpal joint injury.</p>

Clinics in diagnostic imaging (156). Golf-induced hamate hook fracture

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.

Scaphoid dislocation with hamate fracture and proximal migration of distal carpal row / 中华创伤杂志(英文版)

Scaphoid dislocation is a rare injury. Traditionally it has been classified into isolated dislocation and dislocation associated with axial carpal disruption. We present a unique case of scaphoid dislocation associated with proximal migration of the entire distal carpal row as a single unit and hamate fracture with no axial carpal disruption. This injury complex has not been previously described in the literature. The purpose of this case report is to emphasize that in absence of axial carpal dissociation with scaphoid dislocation, a careful evaluation of injury to other bones should be done and treated accordingly to maximize the chances of favourable outcome with reconstructive surgery.

Fibroxantoma intraóseo del hueso ganchoso de la mano izquierda: reporte de caso / Itraosseous fibroxantoma of the left Hamate: case report

El fibroxantoma intraóseo es un tumor raro de curso benigno que puede estar presente en cualquier parte de la anatomía ósea. La gran variedad de diagnósticos diferenciales que posee hace difícil su diagnóstico clínico, imaginológico e histológico. Se presenta el caso de un paciente con dolor en la región dorsal de la mano, con diagnóstico histológico de fibroxantoma intraóseo del hueso ganchoso, junto con una revisión de la literatura de esta patología.

Accessory muscle in the forearm: a clinical and embryological approach / 대한해부학회지

Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The variations of the muscles, especially accessory muscles may simulate soft tissue tumors and can result in nerve compressions. During a routine dissection of the anterior region of the forearm and hand, an unusual muscle was observed on the left side of a 65-year-old male cadaver. The anomalous muscle belly arose from the medial epicondyle approxiamately 1 cm posterolateral to origin of normal flexor carpi ulnaris muscle (FCU), and from proximal part of the flexor digitorum superficialis muscle. It inserted to the triquetral, hamate bones and flexor retinaculum. Passive traction on the tendon of accessory muscle resulted in flexion of radiocarpal junction. The FCU which had one head, inserted to the pisiform bone hook of hamate and palmar aponeurosis. Its contiguous muscles displayed normal morphology. Knowledge of the existence of muscle anomalies as well as the location of compression is useful in determining the pathology and appropriate treatment for compressive neuropathies. In this study, a rare accessory muscle has been described.

Position Change of the Neurovascular Structures around the Carpal Tunnel with Dynamic Wrist Motion

OBJECTIVE: The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. METHODS: Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. RESULTS: The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). CONCLUSION: It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.

Clinical classification and treatment strategy of hamate hook fracture / 华中科技大学学报（医学）（英德文版）

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.

Escisión de la apófisis unciforme del hueso ganchoso / Uncinate process of hamate excision in non-union

Introducción: Las fracturas del gancho del ganchoso son raras, su diagnóstico suele ser tardío y la falta de consolidación es frecuente. Materiales y métodos: Entre 1988 y 2005 fueron operados 14 pacientes que presentaban ausencia de consolidación de la apófisis unciforme mediante su ablación. Se evaluó el tiempo desde el traumatismo y el diagnóstico, los estudios complementarios realizados y la presentación clínica. Todos los pacientes fueron tratados mediante la ablación del gancho del ganchoso. Los resultados fueron evaluados mediante el Mayo Modified Wrist Score. Para la evaluación estadística de los datos se utilizó la prueba de la t de Student. Resultados: El tiempo promedio transcurrido entre el comienzo de las manifestaciones clínicas y el diagnóstico fue de 9 meses (rango 3 a 204 meses). Ocho pacientes presentaron muy buen resultado (57,2 por ciento), 4 bueno (28,6 por ciento), 1 regular (7,1 por ciento) y 1 malo (7,1 por ciento). De los 11 deportistas, 10 volvieron a su nivel anterior. No hubo complicaciones significativas. Conclusiones: La ablación del gancho del ganchoso es una excelente alternativa terapéutica en casos de ausencia de consolidación de la fractura y permite una rápida reinserción a las actividades cotidianas.

Ultrasonographic Findings of Carpal Tunnel after Local Steroid Injection in Carpal Tunnel Syndrome

OBJECTIVE: To evaluate ultrasonographic change of median nerve and flexor tendon in carpal tunnel after local steroid injection in carpal tunnel syndrome (CTS). METHOD: Thirteen patients (24 hands) with CTS diagnosed clinically and electrophysiologically were included. All subjects were examined by ultrasonography with high-resolution linear array transducer and injected with 40 mg of triamcinolone acetonide. The ultrasonography was evaluated with regard to cross-sectional area and the flattening ratio of the median nerve and cross-sectional area of the flexor pollicis longus tenon at pisiform and hamate bone. After 4 weeks, the patients were re-evaluated with electrophysiologic study and ultrasonography. RESULTS: Most patients (11/13) showed improvement of clinical symptoms and electrophysiologic parameters after the local steroid injection. The cross-sectional area of median nerve at pisiform using ultrasonography significantly decreased after the local steroid injection. However, flexor pollicis longus tendon did not show significant change after the injection. CONCLUSION: Local steroid injection in the patients with CTS caused improvement in ultrasonographic findings of median nerve.

Fratura de stress do gancho do hamato: relato de caso com ênfase aos achados de imagem / Stress fracture of hamate's hook: case report with emphasis to the imaging findings

As fraturas de stress do gancho do hamato estão geralmente associadas com atividades esportivas que utilizam tacos, raquetes e bastões. Devido à ausência de um trauma óbvio, o diagnóstico exige maior conhecimento desta lesão e alto índice de suspeição. Os autores relatam o caso de um jogador de golfe com fratura de stress do gancho do hamato, com diagnóstico e acompanhamento realizados por ressonância magnética e tomografia computadorizada multislice.

Stress fractures of the hook of the hamate are related to sports that use devices such as golf clubs, rackets and baseball bats. Because usually there is no history of obvious trauma, the diagnosis necessitates better knowledge of the lesion and high index of suspicion. The authors report a case of stress fracture of the hook of the hamate in a golf player with diagnosis and follow-updone with magnetic resonance and multislice computer tomography.

Fracture - Dislocation of the Body of the hamate / 대한정형외과학회잡지

Fracture-Dislocation of the the body of the hamate is rare in carpal bone fractures. Recently, we experienced two patients with coronal fracture of the dorsal aspect of the hamate with dorsal subluxation of metacarpal bases of the ring and little fingers. The mechanism of injury was by indirect blow with c1enched fist in two patients. Two patients were treated with closed reduction and plaster immobilization for 6 weeks and physical theraphy. At 13 and 14 weeks follow-up respectively, two patients had no funtional limitation, no complaints referable to hand, and nearly solid union on radiographs. We report two cases of fracture of the the body of the hamate bone, associated with dorsal subluxation of hamatometacarpal joint treated by conservative methods and review of literatures.

Fracture of the Body of the hamate: A case report / 대한정형외과학회잡지

The hamate fracture is very rare condition. The mechanism of fracture may be attributed to direct trauma by rolling down. We have experienced a case of fracture of the body of the hamate bone. It was treated by conservative method. The result was satisfactory with conservative treatment without traumatic arthritis, nonunion, ulnar nerve palsy, flexor digitorum profundus tendinitis & limitation of motion. A case of fracture of the body of the hamate bone is reported with brief review of literature.

A Case of Dislocation of the Hamte Bone / 대한정형외과학회잡지

Dislocation of the hemate bone is very rare. There is no reported case in Korea. The mechanism of injury may be attributed to direct trauma. We have experiened a case of dislocation of the hamate bone, treated it by open reduction and internal fixation using two Kirschner wires. The result was satisfactory. A case of dislocation of the hamte bone is reported with brief review of literature.

A roentgenographic study of the appearance of the hook of the hamate / 대한치과교정학회지

The author investigated the timing of land and wrist ossification events taking place in the hamate and pisiform by means of roentgenographic examination and its relation to the peak growth velocities in body height. Materials obtained included 493 sheets of X-ray films taken from 257 boys ana 236 girls aged between 7 and 17 years lived in Seoul area. The results indicate that; 1) The average ages at occurrence of initial ossification of the hook of the hamate were 12 years 3 months in boys and 10 years 1 month in girls. 2) The average ages at which advanced ossification of the hook of the hamate occurred were 13 years 7 months in boys and 11 years 11 months in girls. 3) Initial ossification of the pisiform appeared at 13 years 0 month in boys and 10 years 2 months in girls. 4) All three ossification events in hand and wrist, and peak growth velocity in body height occurred earlier in girls than in boys. 5) Initial ossification in the hook of the hamate and pisiform preceded or coincided with peak growth in body height in most boys and girls, on the other hand, advanced ossification in the hook of the hamate occurred around peak growth in body height but in girls did it after peak growth in body height. 6) It would appear that initial ossification in the hook of the hamate or in the pisiform, both for boys and girls, provides a better indication of approaching peak adolescent growth in body height. 7) Advanced ossification in the hook of the tamale would indicate that the period of cercumpuberal peak growth had teen entered or finished.