Analysis of Wrist Morphology Through Hamate and Lunate Bone Variations in Anatolian Population Using Plain Radiography / Análisis de la Morfología de la Articulación Radiocarpiana a Través de las Variaciones de los Huesos Hamato y Semilunar en la Población de Anatolia Mediante Radiografía Simple

SUMMARY: The present study aimed to evaluate wrist (lunate) anatomy in terms of the incidence of lunatum morphology on plain-radiographs among the Anatolian (Turkey) population, accompanied by demographic analysis. We obtained all the patients' data regarding demographical features, diagnosis, and posteroanterior (PA) X-ray imaging. Two radiograph-reviewers repeated the analysis twice, one month later, blinded to their findings before the previous review. The lunatum structure was determined as Type-1 (n:293) and Type-2 (n:207) for each radiograph. Most of the 500 wrists' radiographs [n:293 (58.6 %)] were type-I lunate. The mean age was 36.7±13.3 (range:18-90) years. Sex distribution was as follows: 185 (63.1 %) males to 108 (36.9 %) females. Type-2 lunate was seen in 207 participants (41.4 %). The mean age for type-2 was 41.6±15.2 (18-88) years. 142 (68.6 %) participants were male sex, while 65 (31.4 %) were females. The mean age of subjects with type-I showed a difference with type-II (p=0.007). There was no relationship in terms of sex (p=0.206) between the groups. In the Anatolian region, type-1 lunate was dominant compared to type-2. The incidence rate of lunate type in Anatolian population was similar to the Arab population.

El presente estudio tuvo como objetivo evaluar la anatomía de la articulación radiocarpiana en términos de la incidencia de la morfología del hueso semilunar en radiografías simples entre la población de Anatolia (Turquía), acompañado de un análisis demográfico. Obtuvimos todos los datos de los pacientes con respecto a las características demográficas, el diagnóstico y las imágenes de rayos X posteroanteriores (PA). Dos revisores de radiografías repitieron el análisis dos veces, un mes después, sin conocer sus hallazgos antes de la revisión anterior. La estructura del lunatum se determinó como Tipo-1 (n:293) y Tipo-2 (n:207) para cada radiografía. La mayoría de las 500 radiografías de muñecas [n:293 (58,6 %)] fueron semilunar tipo I. La edad media fue de 36,7±13,3 (rango: 18-90) años. La distribución por sexos fue la siguiente: 185 (63,1 %) hombres y 108 (36,9 %) mujeres. El semilunar tipo 2 se observó en 207 participantes (41,4 %). La edad media para el tipo 2 fue de 41,6±15,2 (18-88) años. 142 (68,6 %) participantes eran del sexo masculino, mientras que 65 (31,4 %) eran del sexo femenino. La edad media de los sujetos con tipo I mostró una diferencia con el tipo II (p = 0,007). No hubo relación en cuanto al sexo (p=0,206) entre los grupos. En la región de Anatolia, el semilunar tipo 1 era dominante en comparación con el tipo 2. La tasa de incidencia del tipo semilunar en la población de Anatolia fue similar a la de la población árabe.

Wide-Awake Hemi-hamate Arthroplasty for Chronic PIPJ Fracture-Dislocation: A Case Report

@#Wide-awake local anaesthesia, no tourniquet (WALANT) has been reported for upper extremity procedures of varying complexities ranging from simple tendon repairs to more complicated soft tissue and bony reconstructions. Hemihamate arthroplasty under WALANT has yet to be described in English literature. We report a case of a chronic dorsal PIPJ fracture-dislocation who underwent open reduction followed by Hemi-hamate Arthroplasty under wide-awake anaesthesia. There was adequate visualization during the surgery with no additional anaesthesia required. Active intraoperative range of motion and joint stability testing was possible with no pain experienced throughout the procedure. 10-month post-operative follow-up showed excellent range of motion with occasional tolerable pain during maximal finger flexion and power grip. Wide-awake anaesthesia is a viable and safe alternative for hemi-hamate arthroplasty.

Hollow screw in treatment of basilar part fracture of hamate hook / 中国修复重建外科杂志

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.

Features of intra-hamate vascularity and its possible relationship with avascular risk of hamate fracture / 中华医学杂志(英文版)

Background@#The angiography with micro-computed tomography (micro-CT) has been proved its great advantages on investigating the intra-osseous vascularity of carpal bones. But few researches have focused on the intra-hamate vascularity. This study aimed to illustrate the intra-osseous arteries of the hamate and the relationship between the intra-hamate vascularity and the avascular risk of different types of hamate fractures.@*Methods@#Six normal cadaveric hamates were investigated with red lead (Pb3O4) micro-CT angiography. The intra-osseous arteries of specimens were clearly enhanced and the three-dimensional model was reconstructed. In order to study the features of the arterial entrances and intra-hamate vascularity, the diameters, quantities, locations of enhanced arteries, and the locations of transversal/proximal pole fracture lines on the body of the hamate were statistically compared. Besides, in order to analyze the relationship between intra-hamate vascularities and different hamate fractures, 127 cases of hamate fractures who presented in our hospital from March 2003 to June 2017 were retrospectively studied.@*Results@#A total of 94 cases were followed up (range: 4-37 months; mean: 12.4 months) effectively. The overall union rate of hamate fractures was as high as 92.6% (87 of 94 cases), while non-union of fracture on hamate hook was more common (P = 0.031). The arterial entrances were located around the dorsal, volar, radial, ulnar non-articular surfaces of the hamate body and the hook of the hamate. Generally, there were one to two trunk arteries on the volar non-articular surface and one to three trunk arteries on the dorsal non-articular surface. They formed one or two arterial arches, from which some branches were emitted and supplied the proximal parts. The intra-osseous vascularities of the hamate body were generally located in the radial part. The blood supply of the hook was mainly from the volar non-articular surface in most specimens. Hamate fractures could be classified into four types: fractures of the transversal/proximal pole, medial tuberosity, dorsal coronal of the hamate body, and fractures of the hamate hook.@*Conclusions@#This study showed new features of intra-hamate vascularity and the results will guide surgeons to reduce the vascular damage during the hamate fracture operations. The fracture lines of different types of hamate fractures may disrupt the intra-hamate arteries. The intra-hamate vascularities will have different influences on the avascular risks of different hamate fractures.

Effectiveness analysis of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury / 中国修复重建外科杂志

Objective: To explore the effectiveness of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury. Methods: Between September 2015 and June 2017, 13 cases of hamate-metacarpal joint injury were treated, including 12 males and 1 female, aged from 17 to 55 years (mean, 30.8 years). The injury causes included heavy boxing in 10 cases and falling in 3 cases. There were 2 cases of simple fourth metacarpal basal fracture, 1 basal fracture of the fourth metacarpal bone combined with intermetacarpal ligament fracture, 7 fractures of the fourth and fifth metacarpal base, 2 fourth metacarpal basal fractures combined with the fifth metacarpal basal fracture dislocation, and 1 base fracture of fourth and fifth metacarpal bone combined with hamate bone fracture. The time from injury to operation was 5-11 days (mean, 7.2 days). According to different damage degree and stability change between the fourth and the fifth metacarple base, a preliminary classification was made for different degrees of injury: 2 cases of type Ⅰ, 1 case of type Ⅱ, 7 cases of type Ⅲ, 2 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were treated with corresponding internal fixation methods under the principle of stability recovery between the fourth and fifth metacarple base. Results: All the incisions healed by first intention without infection or skin necrosis. All the 13 patients were followed up 6-18 months with an average of 9.4 months. All fractures healed clinically, and the healing time was 5.5-8.0 weeks with an average of 6.3 weeks. No complication such as plate breakage, fracture dislocation, fracture malunion, and bone nonunion occurred. Hand function was evaluated according to the total active motion (TAM) functional evaluation standard of hand surgery at 6 months after operation, and the results was excellent in 9 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 92.3%. Conclusion: Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.

Fractura aislada del cuerpo del hueso ganchoso / Isolated fracture of the body of the hamate bone

Las fracturas del hueso ganchoso son muy poco frecuentes, constituyendo alrededor del 2% de todas las fracturas del carpo. Debido a su baja frecuencia y a lo inespecífico de las manifestaciones clínicas, su diagnóstico suele ser difícil. Es importante considerar su presencia ante un traumatismo directo sobre la mano. Debe estudiarse inicialmente con radiografía de mano. Si es necesario confirmar el diagnóstico o valorar las lesiones asociadas, se sugiere la tomografía axial computarizada. La decisión terapéutica depende del grado de conminución de la fractura, de su estabilidad y de la presencia de compromiso articular. Se presenta el caso de un varón de 19 años que sufrió fractura aislada del cuerpo del hueso ganchoso.

Fractures of the hamate bone are very infrequent, representing approximately 2% of the carpal fractures. Due to its infrequency and to the non-specificity of its clinical manifestations, they are usually difficult to diagnose. Is important to consider its presence when a direct trauma over hand occurs. Study should start with X ray of the hand. If necessary to confirm the diagnosis or assess associated lesions, computed tomography is suggested. The therapeutic management depends on the degree of comminution of the fracture, its stability and any joint involvement. We present a case of a 19 year old male who suffered an isolated fracture of the body of the hamate bone.

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.

Hamate Hook Fracture with Flexor Tendon Ruptures as a Golf Injury

PURPOSE: We report surgical results and the relationship between hamate hook fracture and flexor tendon rupture occurred during excessive golf practice or rounding. METHODS: The 16 cases of patients with fracture of hamate hook or flexor tendon injury caused by golf swing were examined retrospectively. Hamate hook excision were underwent in fracture alone, flexor tendon reconstruction with tendon transfer of 3rd or 4th flexor digitorum sublimus (FDS) were done in the flexor tendon rupture. Postoperative results were evaluated by means of American Society for Surgery of the Hand (ASSH) to compare total range of motion and the grip strength. RESULTS: The fracture gap was not far apart completely in computed tomography (CT) of hamate fracture alone cases. If the flexor tendon rupture with the fracture, the gap in CT was far apart completely. After flexor tendon transfer surgery, two cases were excellent, five cases were good, two cases were fair in ASSH assessment. One case was re-rupture. Grip strength as compared with the normal side was observed for the mean grip strength of 82% recovery. CONCLUSION: The instability of the hamate hook fracture affected to flexor tendon rupture rather than location of the fracture. Hamate hook excision and tendon transfer with FDS can be a good treatment option.

Pathology and therapeutic results in patients with intraosseous ganglia of the carpal bone / Patología y resultados terapéuticos en los pacientes con ganglión intraóseo del hueso carpiano

This study evaluated the pathology and therapeutic results of seven patients with intraosseous ganglia of the carpal bone. The mean age at the time of surgery was 27.6 years. The lesions were localized in the proximal carpal row in six patients and in the distal carpal row in only one. Surgical treatment was performed in all patients with good bone union. None had pain during activity or at rest and no recurrence had occurred. The intraosseous ganglia in four patients was of the idiopathic type, and in the other three patients was of the penetrating type. Although intraosseous ganglia of the carpal bone is reported as a rare disease, there were 159 cases in the literature. The pathology was intra- or extraosseous development, showing variation, but most cases were localized in the proximal carpal row.

Este estudio evaluó la patología y resultados terapéuticos de siete pacientes con ganglión intraóseo del hueso carpiano. La edad promedio en el momento de la cirugía fue 27.6 años. Las lesiones se localizaban en la fila proximal del carpo en seis pacientes y en la fila distal carpiana solamente en uno. El tratamiento quirúrgico se realizó en todos los pacientes con buena unión ósea. Ninguno tuvo dolor durante la actividad o el reposo, y no había tenido lugar recurrencia alguna. El ganglión intraóseo en cuatro pacientes fue de tipo idiopático, y en los otros tres pacientes fue de tipo penetrante. Aunque el ganglión intraóseo del hueso carpiano se informa como una enfermedad rara, se reportaban 159 casos en la literatura. La patología consistía en un desarrollo intra- o extraóseo, con variación, pero la mayoría de los casos se localizaban en la fila proximal carpiana.

Early Results of Hemicondylar Hamate Replacement Arthroplasty in Proximal Interphalangeal Fracture-Dislocation Injury

PURPOSE: We assessed early clinical and radiological results of hemicondylar hamate replacement arthroplasty in fracture-dislocation injury of the proximal interphalangeal joint. MATERIALS AND METHODS: From March 2007 to February 2008, four patients who had suffered from comminuted unstable fracture-dislocation of the proximal interphalangeal joint were treated by hemicondylar hamate replacement arthroplasty. All patients were male, and average age at operation was 21.5(range, 14~27) years. All cases showed subluxation of the proximal interphalangeal joint, and mean articular surface involvement was 50.8(range, 42.1~62.5)%. We clinically measured ROM, grip strength, pain of donor & recipient site, and radiologically assessed whether or not union, malalignment, or step-off occurred. RESULTS: Average follow-up period was 9.5(range, 6~14) months. Mean flexion contracture was 12.5 (range, 10~15)degrees in affected side and 0degrees in unaffected side. Mean further flexion was 92.5 (range, 85~100)degrees in affected side and 95.0 (range, 90~100)degrees in unaffected side. Mean VAS pain scores was 1.75 (range, 1~3) in recipient site and 1.25 (range, 0~2) in donor site. Mean grip strength was 11 (range, 8~15) lb in affected side and 14 (range, 10~17) lb in unaffected side. Union without malalignment was achieved in all cases. CONCLUSIONS: Early results of hemicondylar hamate replacement arthroplasty in the treatment of fracture-dislocation of the proximal interphalangeal joint showed satisfactory functional and radiological outcome.

Fracture-Dislocation of the Carpometacarpal Joint with the Fracture of Hamate

PURPOSE: To evaluate the classification and treatment results about the injury of carpometacarpal (CMC) joint with the fracture of hamate. MATERIALS AND METHODS: The authors categorized into 3 types (I, II, III) according to the location of injured CMC joint and type II was subdivided into 2 type (a, b) according to the size of coronal fragment of hamate fracture-type I: fracture-dislocation of 5th CMC joint with small-sized fragment or avulsion fracture of hamate, type IIa: fracture-dislocation of 4th and 5th CMC joint with small-sized fragment or avulsion fracture of hamate, type IIb: fracture-dislocation of 4th and 5th CMC joint with coronal fracture of hamate body presenting an oblique or coronal splitting fracture, and type III: type II injury associated with injury of 3rd CMC joint or coronal plane fracture of capitate. All cases were carried out the operative treatment. And radiologic results and clinical results were evaluated. RESULTS: Type I were 2 cases, type IIa 4, type IIb 5, and type III 3. Twelve of 14 cases were excellent or good results, 1 case (type III) was fair, and 1 case (type IIa) was poor. All cases obtained anatomic reduction of CMC joint. But, the posttraumatic arthritis was observed in 1 case (poor) and the displacement of non-fixed hamate fragment was observed in 1 case (fair). CONCLUSION: We think that it may get more favorable outcomes by the fixation of the relative large fragment of hamate with anatomical reduction of CMC joint.

Fragment Excision for the Treatment of Hamate Hook Nonunion / 대한정형외과학회잡지

PURPOSE: To evaluate the treatment results of fragment excision of the hamate hook nonunion. MATERIALS AND METHODS: Nine patients operated for hamate hook nonunion were reviewed retrospectively, and were clinically assessed for pain, range of motion, tingling sensation, and grip strength postoperatively. RESULTS: The initial symptoms were pain (3 cases), tingling sensation (3 cases), 5th DIP joint flexion LOM (2 cases), and pain and accompanying LOM in 5th DIP joint flexion (1 case). The causes of injuries seemed to be mainly associated with sports activities. Time from initial symptom to diagnosis was averaged 15 months (2 months-5 years), and confirmative image was plain x-ray (one case), carpal tunnel view (six cases), and CT scan (two cases). All patients underwent fragment excision, and in three patients with accompanying carpal tunnel syndrome, transverse carpal ligament release was performed accordingly. In three other patients complicated with 5th FDP rupture, tenorrhaphy was performed in two cases, and tendon transfer was performed in the other case. Eight patients showed excellent clinical results one year postoperatively, but one patient complained of transient tingling sensation on the 4th and 5th fingers. CONCLUSION: Hamate hook excision after nonunion showed excellent clinical results in one year postoperative follow-up.

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.

Treatment of Unstable Dorsal Proximal InterphalangealFracture/Dislocation using a Hemi-Hamate Autograft / 대한정형외과학회잡지

PURPOSE: To evaluate clinical and radiology assessments of the treatment outcomes of an unstable dorsal proximal interphalangeal (PIP) fracture and dislocation by hemi-hamate autograft. MATERIALS AND METHODS: Six patients underwent a hemi-hamate autograft for the treatment of an unstable dorsal PIP fracture dislocation of which the articular involvement of the PIP joint was >50%, or an unstable joint despite the lesser degree of involvement. The clinical results were evaluated from the following: postoperative patient satisfaction, range of motion, stability and grip strength. The radiographs were evaluated for the union, and graft incorporation, and/or collapse. RESULTS: All patients were satisfied with the results and the range of motion of the PIP joint was 81 degrees (75-100 degrees). In all cases, stability of the PIP joint was restored. The average grip strength was 82% (75-90%) of the uninjured side. Bone union was achieved in all patients. CONCLUSION: A hemi-hamate autograft is effective for reconstructing the cup-shaped contour of the articular surface, and for recovering the functional range of motion of the PIP joint after an unstable dorsal proximal interphalangeal (PIP) fracture and dislocation. However, more study will be needed through a mid-term and long-term follow up.

Non-union of Golf Related Fracture of the Hook of Hamate: A case report

We presented a 64-year-old man who complained sudden onset of ulnar sided wrist pain, paresthesia in ulnar aspect of left hand after swinging a golf club. The intermittent pain was not relieved by physical therapy, local injection and medication on local clinics. Physical examination revealed tenderness on the area of the hook of hamate and weakness on flexion of 5th finger in the left side. Plane X-ray and electrodiagnostic study did not show abnormal findings. Bone scan revealed increased uptake localized on left ulnar site of wrist joint. For proper diagnosis, MRI and carpal tunnel view of left wrist were performed and fracture of the hook of hamate was found. We reported a case of non-union of golf related fracture of the hook of hamate by delayed diagnosis with the review of literatures.

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.