Chondroblastoma with secondary aneurysmal bone cyst of the hamate: case report

Chondroblastoma of the carpals is rare, can mimic other benign bone tumors, and presents a diagnostic challenge. There have been few cases of benign tumors involving the hamate, with only one reported case of chondroblastoma, which was treated with complete hamate excision. We present a case of chondroblastoma with secondary aneurysmal bone cyst of the hamate treated with curettage, high-speed burring, phenol, and autogenous iliac crest bone grafting. At the time of the most recent radiographic follow-up, there was full graft incorporation, preserved hamate morphology, and no evidence of recurrence.     

Fracture of the body of the hamate bone

Summary A patient with a fracture of the body of the hamate bone associated with a proximal and dorsal subluxation of the fifth metacarpal is reported. Treatment consisted of closed reduction and Kirschner wire fixation. A short discussion on fractures of the hamate bone is given.

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Zusammenfassung Bericht über einen Patienten mit Fraktur im Bereiche des Körpers des Os hamatum und gleichzeitiger Subluxation des 5. Metacarpale nach proximal und dorsal. Die Behandlung bestand in geschlossener Reposition und Kirschnerdraht-Fixation. Die Frakturen des Os hamatum werden kurz diskutiert.

     

Avascular necrosis of the hamate treated with capitohamate and lunatohamate intercarpal fusion

This article describes a case of a 58-year-old man with no significant underlying disease who had chronic pain due to osteonecrosis of the hamate. Following physical examination, imaging, and laboratory findings, he underwent surgical exploration via a limited dorsal approach. The hamate bone did not have a normal anatomical appearance or structure. It was marble-like in appearance, soft, friable, and lacking physiologic contour and bone strength. We removed the dorsal aspect of the hamate piecemeal. The articular surfaces of the adjacent carpal bones (capitate and lunate) were excised, and the lesion was packed with iliac autograft. Three months postoperatively, fusion of the remaining hamate and the adjacent capitate and lunate carpal bones was evident, and the patient reported mild wrist pain, moderate grip strength improvement, and mild improvement of wrist range of motion and stiffness. Currently, no standard treatment algorithm exists for patients with avascular necrosis of the hamate. However, delayed diagnosis of this clinical entity can be debilitating. A high index of clinical suspicion and an early course of treatment offers considerable benefits to patients with osteonecrosis of the hamate.     

Nonunion of the hook of the hamate: an argument for bone grafting the nonunion

A technique of bone grafting the ununited hook of the hamate is presented as an alternative to simple excision of the nonunion fragment. The procedure was successful in four patients. The advantages of preserving the hook of the hamate for the pulley effect on the flexor profundi are discussed.     

Avascular necrosis of the hamate: A case report with reference to the hamate blood supply

Avascular necrosis of the hamate bone has not previously been reported. In this case the proximal fragment of the fractured hamate underwent avascular necrosis and prolonged healing. In an attempt to explain this sequela, angiography of the cadaver carpus followed by dissection of intact wrists and a study of enzyme-cleaned hamates showed that their wedge-shaped proximal segments were mostly enveloped by a distal extension of the midcarpal joint cavity and thus totally dependent on intraosseous nutrition. Consequently, the segment is at risk when a fracture line transects the body proximal to the base of the wedge. Clinically, this condition resulted in persistent discomfort and limitations of motion. A postinjury bone scan of the wrist indicated avascular changes in the proximal third of the hamate, and a delayed union was followed by later revascularization and a more normal scan image.     

Giant cell tumour of the hamate. Case report.

We report the case of a 31-year-old woman who had had the distal end of the ulna resected for a giant cell tumour five years before presenting with a further one in the hamate. The medullary cavity of the hamate was curetted and cancellous bone grafted from the distal radius. Her symptoms resolved, and 26 months postoperatively the cortex of the hamate was fully restored.     

Dislocation of the hamate associated with fracture of the trapezial ridge

A case of dislocation of the hamate bone, associated with palmar ridge fracture of the trapezium, is described. The mechanism of this injury is thought to be traction force through the transverse carpal ligament caused by a flattening of the transverse carpal arch.     

Isolated dislocation of the hamate bone

A case of isolated dislocation of the hamate bone is reported. Mechanism of the injury and treatment are described including a review of the literature. Received: 9 December 1998     

Hook of the hamate fractures in competitive golfers: results of treatment by excision of the fractured hook of the hamate

Seven competitive golfers presented with isolated fractures of the hook of the hamate. All patients were treated with excision of the fractured hook of the hamate, with complete resolution of pain. All patients returned to their previous level of play. It is reasonable to deduce, with this group of patients, that this fracture pattern represents an overuse or repetitive motion injury. Regardless of etiology, prompt diagnosis and treatment of this injury with excision of the fractured hook of the hamate bone allows competitive golfers to return to their previous level of competition.     

单纯钩骨钩骨折致尺神经深支损伤的临床研究

目的探讨单纯钩骨钩骨折致尺神经深支损伤的致病机理。方法采用16侧甲醛固定和4侧新鲜成人尸体标本。以钩骨钩中点为O,过O点作一条水平线及垂线,水平线与尺神经深支的交点为A点,与钩骨钩基底尺侧交点为B点,垂线与尺神经的交点为C点,分别测量OA、OB、OC、AB长度,并进行统计学分析;对1996年4月~2009年6月5例单纯钩骨钩骨折合并尺神经深支损伤进行回顾分析。结果尺神经深支绕过钩骨钩的基底部进入掌深间隙,OA的长度为(4.96±0.11)mm、OB的长度(3.69±0.12)mm、OC的长度(10.55±1.07)mm、AB的长度为(1.27±0.15)mm;5例根据中华医学会手外科学会上肢周围神经功能评定试用标准:优4例,良1例。结论单纯钩骨钩骨折可致尺神经深支损伤但临床容易漏诊,早期正确诊治是神经功能得以恢复的关键。     

Aseptic necrosis of the hamate: a case report.

The case of a 25-year-old man with osteonecrosis of the hamate is reported. He had pain and swelling in his right wrist. The diagnosis was accomplished with plain radiographs as well as with MRI. The case was treated surgically that included resection of the necrotic bone. The occured cavity was filled with autogenous cancellous bone graft. In addition, capito-hamate arthrodesis was performed. Histopathological examination following the operation demonstrated avascular necrosis of the hamate. The arthrodesis was obtained four months after the operation.     

Recurrent osteoblastoma of the carpal hamate

A case of recurrent osteoblastoma of the hamate is reported. Curettage and bone grafting is usually followed by recurrence. Wide excision of the tumor is the treatment of choice if anatomically feasible.     

Solid variant of aneurysmal bone cyst of the hamate

Solid variant of aneurysmal bone cyst is a variant of aneurysmal bone cyst in which the predominant histology is that of the solid material of a cystic aneurysmal bone cyst. In this article, we present a patient with solid variant of aneurysmal bone cyst of the hamate and discuss the differential diagnosis and current treatment for this lesion.     

Aneurysmal bone cyst in the hamate

Aneurysmal bone cysts (ABCs) show a predilection for the metaphysis of the long bones and the vertebrae and seldom involve the carpal bones. We present a case of an ABC in the left hamate of an 18-year-old man. Curettage and bone grafting were performed, and, because destruction of the cortex was extensive, the hamate was excised. At 3-year follow-up, the wrist was stable.     

Medial (hamate) facet of the lunate

One hundred sixty-five cadaveric wrists were dissected to assess the incidence of a medial (hamate) facet on the lunate and any associated pathologic conditions. Forty-seven of these specimens and 137 clinical patients' radiographs were reviewed to attempt to recognize and further assess the incidence of a medial (hamate) facet on the lunate. Two types of lunate were identified. Type I, in which there was no medial facet, was evident in 34.5% of the dissected specimens and type II, in which there was a medial facet, was evident in 65.5% of the dissected specimens. The medial facets in the type II lunates ranged from a shallow 1 mm facet to a deep 6 mm facet. Significant cartilage erosion with exposed subchondral bone at the proximal pole of the hamate, which was not identifiable by radiograph, was evident at dissection in 44.4% of the type II lunates, while none (0%) of the type I lunates had such associated hamate pathologic conditions. This type II lunate, with the high incidence of associated hamate pathology, may be an unidentified cause of wrist pain on the ulnar side.     

GIANT CELL TUMOUR OF THE HAMATE

We report the case of a 31-year-old woman who had had the distal end of the ulna resected for a giant cell tumour five years before presenting with a further one in the hamate. The medullary cavity of the hamate was curetted and cancellous bone grafted from the distal radius. Her symptoms resolved, and 26 months postoperatively the cortex of the hamate was fully restored.     

Avascular necrosis of multiple carpal bones. A case report

A case of a 66-year-old female patient with hyperlipaemia, corticosteroid osteoporosis and chronic obstructive lung disease with avascular necrosis of the proximal row of the carpus and hamate is described. No other sites of avascular bone necrosis were found. A proximal row carpectomy was performed with an excellent outcome.     

Hamato-lunate impingement: an uncommon cause of ulnar-sided wrist pain.

It has been reported that almost 50% of lunates have a separate medial facet on the distal surface for articulation with the hamate; about a quarter of these have erosion of the cartilage with exposed subchondral bone on the proximal pole of the hamate. We describe 4 cases of ulnar-sided wrist pain caused by hamato-lunate impingement that resulted in chondromalacia. The pain could be reproduced by a modification of the Lichtman test. The diagnosis was confirmed by arthroscopy. All 4 patients responded favorably to resection of the head of the hamate.     

Traumatic dislocation of the hamate and pisiform: a case report and review of the literature

Isolated dislocation of the hamate bone and pisiform bone is rare. We describe the simultaneous complete dislocation of both the hamate and pisiform bones in a 27-year-old man who crushed his right hand in a rolling press. An open reduction and internal fixation with Kirschner wires was performed. Four weeks later, the Kirschner wires were removed and rehabilitation was started. At 6 months follow-up, the patient had minimal pain and full range of motion in the affected wrist joint and fingers. However, grip strength was 50% compared to his unaffected left hand, and sensation of the ulnar nerve area was reduced to almost 30% of that of his left hand. It appears that the ulnar nerve injury was the largest contributing factor to the poor outcome of our patient. Evaluation of soft-tissue injuries, especially nerve injury, is important in the treatment of complex carpal dislocations.     

The lunatohamate articulation of the midcarpal joint

Sixty-one cadaveric wrists were dissected to assess the frequency of a medial lunate facet as well as any associated pathologic changes in the midcarpal joint. Two types of lunate were identified: Type I (39.3%), in which no medial facet was present, and Type II (60.7%), in which there was a medial facet. The medial facets in the Type II lunates ranged from a shallow 2 mm facet to a deep 6 mm facet. Significant cartilage erosion with exposed subchondral bone at the proximal pole of the hamate, which was not identifiable by radiograph, was evident at dissection in 57% of the Type II lunates, whereas none (0%) of the Type I lunates had such associated hamate pathology. Midcarpal joint arthroscopy appears to be the diagnostic procedure of choice to assess the presence of hamate proximal pole arthrosis.