ABSTRACT
OBJECTIVE: The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic. MATERIAL AND METHOD: We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed. RESULTS: The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body. CONCLUSIONS: The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study.
Subject(s)
Fracture Fixation/methods , Fractures, Bone/surgery , Hamate Bone/injuries , Wrist Injuries/surgery , Adult , Delayed Diagnosis , Female , Follow-Up Studies , Fractures, Bone/diagnosis , Hamate Bone/surgery , Humans , Male , Middle Aged , Retrospective Studies , Wrist Injuries/diagnosisABSTRACT
The idiopathic avascular necrosis of the scaphoid or Preiser's disease is condition about which few cases have been described. In the majority of cases, it is debatable whether it is actually a spontaneous osteonecrosis, or a pathological process secondary to a systematic disease, or a result of chemotherapy treatment, or associated with taking steroids. We present the case of a 20-year old woman, with no previous trauma, with pain in her right wrist, which progressed over a period of four years. It was wrongly diagnosed as a tendinitis, and was treated conservatively without any improvement. A simple X-ray was requested that showed an abnormality of the proximal pole of the scaphoid that was beginning to fragment; a fact which was confirmed later by performing a CT scan. This was followed by nuclear magnetic resonance spectroscopy (NMR), which showed signs of ischaemia, mainly in the proximal pole. There were signs of viability in the distal fragment in the NMR using paramagnetic contrast. After the imaging tests, idiopathic avascular necrosis of the scaphoid was diagnosed. The surgical treatment consisted of the removal of necrotic fragments of the proximal pole and removal of the posterior interosseous-nerve. Two years after the intervention, the patient is asymptomatic and with a complete range of movement in the operated wrist.
Subject(s)
Osteonecrosis/diagnosis , Scaphoid Bone , Female , Humans , Magnetic Resonance Imaging , Scaphoid Bone/diagnostic imaging , Tomography, X-Ray Computed , Young AdultABSTRACT
La necrosis avascular idiopática del escafoides o enfermedad de Preiser es una entidad de la que se han descrito pocos casos. En algunas ocasiones es discutible si se trata de una osteonecrosis espontánea o representa un proceso patológico secundario a enfermedades sistémicas, tratamiento quimioterápico o está relacionada con el consumo de esteroides. Presentamos el caso de una mujer de 20 años de edad, sin traumatismo previo, con dolor en la muñeca derecha de 4 años de evolución. Había sido erróneamente diagnosticada de una tendinitis y tratada de forma conservadora sin mejoría. Se solicitaron estudios de imagen mediante radiología simple. Los hallazgos radiológicos presentaban una anomalía del polo proximal del escafoides que originaba una fragmentación del mismo, hecho que se confirmó posteriormente con la realización de una TC. A continuación se realizó una RMN en la que se observaron criterios de isquemia, fundamentalmente en polo proximal. En la RMN con contraste paramagnético aparecieron signos de viabilidad en el fragmento distal y de osteonecrosis en el proximal. Tras las pruebas de imagen se diagnosticó de necrosis avascular idiopática del escafoides. El tratamiento quirúrgico consistió en extirpar los fragmentos necróticos del polo proximal y practicar una neurectomía del nervio interóseo posterior. A los 2 años de la intervención, la paciente se encuentra asintomática y con un balance articular completo de la muñeca intervenida (AU)
The idiopathic avascular necrosis of the scaphoid or Preiser's disease is condition about which few cases have been described. In the majority of cases, it is debatable whether it is actually a spontaneous osteonecrosis, or a pathological process secondary to a systematic disease, or a result of chemotherapy treatment, or associated with taking steroids. We present the case of a 20-year old woman, with no previous trauma, with pain in her right wrist, which progressed over a period of four years. It was wrongly diagnosed as a tendinitis, and was treated conservatively without any improvement. A simple X-ray was requested that showed an abnormality of the proximal pole of the scaphoid that was beginning to fragment; a fact which was confirmed later by performing a CT scan. This was followed by nuclear magnetic resonance spectroscopy (NMR), which showed signs of ischaemia, mainly in the proximal pole. There were signs of viability in the distal fragment in the NMR using paramagnetic contrast. After the imaging tests, idiopathic avascular necrosis of the scaphoid was diagnosed. The surgical treatment consisted of the removal of necrotic fragments of the proximal pole and removal of the posterior interosseous-nerve. Two years after the intervention, the patient is asymptomatic and with a complete range of movement in the operated wrist (AU)
