Displaced dorsal oblique fracture of the hamate treated with a cortical mini lag screw

A dorsal oblique fracture of the hamate was associated with a dorsal dislocation of the base of the fifth metacarpal. Open reduction and internal fixation of the fracture with a cortical mini lag screw achieved an excellent result in union, joint restoration, and function.     

Divergent fracture-dislocation of the hamatometacarpal joint: case report

Hamatometacarpal fracture-dislocation is a rare injury that consists of a fourth metacarpal fracture and a fifth carpometacarpal joint injury. We present the case of a 21-year-old man with a divergent hamatometacarpal fracture-dislocation that consisted of a combination of dorsal intra-articular fracture-dislocation of the fourth carpometacarpal joint, palmar dislocation of the fifth carpometacarpal joint, and fracture of the hook of the hamate. The mechanism of palmar dislocation of the fifth metacarpal base and fracture of the hook of the hamate involved extension of the fifth metacarpal and ulnopalmar load transmission.     

骑缝钉固定治疗钩掌关节损伤

目的：探讨应用骑缝钉固定治疗钩掌关节损伤的疗效。方法： 2009年5月至2012年11月应用骑缝钉固定治疗钩掌关节损伤16例,其中男10例,女6例;年龄21～57岁,平均33.6岁。单纯第4和（或）第5掌骨基底脱位11例;第4和（或）第5掌骨基底脱位伴钩骨背侧撕脱性骨折5例。定期复查X线片了解骨折愈合、关节复位及骑缝钉位置情况,采用手指关节总活动度（TAM）系统评定法评价腕掌关节及掌指关节功能。结果：所有患者切口均I期愈合,未发生感染。所有病例均获随访,时间6～24个月,平均（10.0±2.7）个月,无再发脱位,内固定位置良好,无退钉、断钉。5例伴有钩骨背侧撕脱性骨折的患者获得良好骨性愈合。腕掌关节及掌指关节功能：优10例,良5例,中1例。结论：骑缝钉固定治疗钩掌关节损伤具有操作简单,创伤小,固定可靠,术后早期功能锻炼等优点,是治疗钩掌关节损伤的理想手术方式。     

Fourth and fifth carpometacarpal fracture and dislocation of the hand: new classification and treatment

Cain’s classification of fourth and fifth carpometacarpal (CMC) fracture and dislocation does not include the intraarticular metacarpal (MC) base fracture that may influence the treatment outcome. We reviewed 37 cases of fourth and fifth CMC fracture and dislocation treated with operative method, and we have devised a new classification based on the articular surface of the hamate and the involvement of the MC base. These injuries were divided into three types (type I, involved less than one-third of hamate articular surface; type II, involved more than one-third; and type III, coronal splitting of hamate). Each type was divided into four subtypes (a, absence of intraarticular MC base fracture; b, fourth MC base fracture; c, fifth MC base fracture; d, both fourth and fifth MC base fractures). Twenty cases were classified as type I, 16 as type II and 1 as type III. Stable hamate fracture (type I) was treated with closed reduction and percutaneous fixation, whereas unstable fracture (II and III) was treated with open reduction. Thirty-five of 37 patients showed excellent or good outcomes according to the Kumar’s criteria at 1?year postoperatively. The new classification classifies the fourth and fifth CMC fracture and dislocation in detail and appears to be more useful clinically.     

A novel hamatometacarpal fracture-dislocation classification system based on CT scan

PurposeThe purpose of this study was to devise a novel classification of a hamatometacarpal fracture–dislocation based on the preoperative computed tomography (CT) and plain radiography that provided more information to surgeons regarding appropriate treatment methods.Materials and methodsTwenty-one patients with a hamatometacarpal fracture–dislocation were enrolled in this study. The classification scheme devised for hamatometacarpal fracture–dislocation is summarised as follows: type I – a simple dislocation; type IIA – a dislocation with the fourth metacarpal base intra-articular fracture; type IIB – a dislocation with a dorsal hamate fracture of less than one-third of the articular surface; and type III – a dislocation with a dorsal hamate fracture of more than one-third of the articular surface.ResultsType I injury was treated conservatively after closed reduction. Type IIA and IIB injuries were treated by percutaneous K-wire fixation. Type III injury was treated by open reduction and internal fixation. All injuries were well managed in both clinical and radiographic evaluations, without apparent complications.ConclusionThe novel classification system for hamatometacarpal fracture–dislocation can be used to establish guidelines for appropriate treatment.     

Complex fracture-dislocation of the carpometacarpal joint associated with a fracture of the hamate: a case report

Abstract We report a case of carpometacarpal dislocation associated with a fracture of the hamate, an extra-articular fracture of the base of the first metacarpal and a rotated volar dislocation of the scaphoid. These lesions are not common and are sometimes misdiagnosed because of nonspecific symptoms and the difficulty of interpreting the radiographs. Open reduction and stabilization with Kirschner wires was performed. We removed the cast and wires after 4 weeks and the patient was sent to a rehabilitation program. When reviewed 18 months later, he had recovered complete hand function without pain or other symptoms, even after heavy manual activities.     

Isolated radial palmar dislocation of the fifth carpometacarpal joint with ulnar neuropathy associated: successful treatment with closed reduction and internal fixation

Carpometacarpal dislocations may be dorsal, volar or divergent type but most are dorsal with involvement of fourth and fifth metacarpal. Isolated volar dislocation of the fifth carpometacarpal joint is an uncommon injury specially when there is no associated fracture. We report a case of radial palmar dislocation of the base of fifth carpometacarpal joint associated to compression of the fourth interdigital nerve in the hand.     

Open irreducible fracture/dislocation of the four ulnar metacarpals at the metacarpophalangeal joints: case report

Open irreducible fracture/dislocation of multiple metacarpophalangeal joints is an exceedingly rare injury and, to our knowledge, not yet described in the literature. An earlier belief that metacarpophalangeal dislocations were high-energy injuries is questioned by this case report due to an unusual case of open irreducible fracture/dislocation of the four ulnar metacarpals that occurred in a hand trauma. A 24-year-old man presented in the emergency department with an open irreducible fracture/dislocation of the four ulnar metacarpals and impaired flexion of the metacarpophalangeal joint of his left hand. The injury was described as an open injury of his third metacarpal head with an associated fracture of the fourth metacarpal head and dorsal dislocation of the four ulnar metacarpals after a fall onto the outstretched hand. Early recognition and anatomical reduction are essential to achieve good long-term outcomes. Massive edema, interposed volar ligaments, and overlapping metacarpal bases are the usual obstacles to a successful closed reduction. Use of a palmar approach was the key to reduce the displacement. Joint stability and osteosynthesis with K-wires were achieved, and the patient has been asymptomatic for more than 24 months.     

Intramedullary stabilisation of hematometacarpal fracture-dislocation. A case report

We report a case of a dorsal coronal fracture of the hamate associated with an unstable hematometacarpal dislocation in a 15 year old patient. An accurate assessment was done only after a 3D-CT was performed. Open reduction and intramedullary fixation yielded a very good result.     

Rare double fracture-dislocation of the thumb： a case report and review of the literature

Simultaneous fracture/dislocation of the thumb carpometacarpal (CMC)joint and dislocation of the metacarpophalangeal (MCP)joint is considered as a rare injury pattern.We report an unusual case of dorsa...     

Fracture of the body of the hamate bone. Case report

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.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

Complex carpal dissociation with open, complete, and divergent trapezium, capitate, and hamate dislocation: a case report

We report a patient with a unique complex carpal dissociation involving complete and divergent dislocation of the hamate, capitate, and trapezium with total ligamentous disruption of the distal carpal row and midcarpal joint, associated with a transverse shaft fracture of the fifth metacarpal. The mechanism of injury was a sustained torsional force resulting in a simultaneous distraction and bidirectional dorsopalmar (ulnar)-palmodorsal (radial) crushing force at the carpus.     

Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: A case report and review of literature of the last 20 years

INTRODUCTIONFractures of the carpal bones are often difficult to diagnose and treat due to the complex bone architecture of this region. Hamate fractures, particularly body fractures, are extremely uncommon.PRESENTATION OF CASEWe present a case of a coronal fracture of the hamate associated with a fracture of the base of the fourth metacarpal, which was treated by open reduction and internal fixation.DISCUSSIONSome of hamate body fractures are associated with other injuries like metacarpal fractures. Its diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination. This fracture is a very rare lesion that can raise questions about their most adequate diagnostic and therapeutic approaches.CONCLUSIONAfter reviewing the literature, we conclude that there is a high rate of delay in the diagnosis of these lesions, probably due to their rarity and to the lack of radiological studies specifically targeting this region. Despite this, surgical treatment in its different modalities has been shown to have the best clinical and functional results.     

The mechanism of dorsal fracture dislocation of the fifth carpometacarpal joint.

Fracture dislocation at the base of the fifth metacarpal is a rare injury. Fewer than 25 cases have been published in the English-language literature. A force acting along the longitudinal axis of the fifth metacarpal causes a fracture dislocation at the base of the bone in a dorsal-ulnar direction, because of the anatomy of the joint and the mechanical properties of the bone and the intermetacarpal ligament. The mechanism of other types of injury to this joint, namely dorsal-radial or palmar-radial dislocation of the base of the fifth metacarpal is different. A case is presented which demonstrates the mechanism of the fracture dislocation.     

Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries

PURPOSE: The purpose of this study was to detail the pathomechanics and pathoanatomy of fracture dislocations of the ring finger and small finger carpometacarpal (CMC) joint by duplicating the pathomechanics of the fist blow. METHODS: A custom-made jig was used to position 20 fresh-frozen cadaver upper extremities in forearm neutral rotation, 90 degrees of elbow flexion, 20 degrees of wrist extension, and 20 degrees and 30 degrees of flexion at the ring and small finger CMC joint, respectively. First 7.7 kg of weight were dropped from a height of 0.76 m to 1.1 m to axially load the ring and small metacarpal (MC) heads through a custom-made apparatus. Fluoroscopic examination before and after loading, and detailed dissection after loading, were used to identify any osseous and/or ligamentous injuries. RESULTS: The most common fractures were a dorsal capitate fracture and a middle MC dorsal base fracture. The most common combinations of fractures were the dorsal capitate and dorsal hamate fractures. Multiple fractures often were identified in a number of locations including dorsally: the capitate, hamate, and index through small metacarpal bases, and volarly: the hook of the hamate and the middle through the small MC bases. CONCLUSIONS: The patterns of injuries encountered at the ring and small CMC joints can be explained by the direction and force of the applied load, position of the CMC joint at the time of loading, and the constraints imposed by specific CMC ligaments. A detailed analysis of the fracture patterns and associated ligament anatomy suggests that the typical ring and small carpometacarpal fracture dislocations are a more complex combination of fractures than identified by plain radiographs alone. The complexity of these injuries is greater than previously recognized and is most likely the result of a combination of axial load and shear stresses resulting in carpal fractures and ligament avulsions as well as fracture dislocations. This study suggests that computed tomography may be the preferred diagnostic imaging method for complete assessment of these injuries.     

Carpometacarpal dislocation of the fifth finger: descriptive study of 31 cases

OBJECTIVES: Carpometacarpal dislocation of the little finger is a rare and little known injury. We performed a 10 years retrospective study of all the cases in our unit in order to improve comprehension and treatment of this disease. METHODS: Thirty-one patients were included in this study. All the dislocations were dorsal with 5 isolated fifth carpometacarpal dislocations, 6 fracture-dislocations of the base of the fifth metacarpal, 19 fourth and fifth dislocations and one third-fourth-fifth dislocation. Diagnosis of the injury was made early in only 19 patients. 30 had surgical management, 28 with percutaneous K-wires, and 2 through a metacarpalhamate arthrodesis. RESULTS: Twenty-six patients were available for follow-up at an average of 6 months and 5 patients were lost for follow-up. Twenty-five patients had satisfactory results. A reflex sympathetic dystrophy delayed the recovery for one patient. There was no recurrence of dislocation at follow-up. There was no complication necessitating revision surgery. CONCLUSION: Diagnosis of carpometacarpal dislocation of the little finger can be performed with conventional radiographic examination; computer-tomography is helpful to confirm an associated fracture of the carpus. The goal of treatment is early reduction and fixation of the metacarpal. There is no recommendation for operative technique based on scientific evaluation. Early diagnosis is the key to success.     

A rare case of closed isolated dislocation of the third metacarpophalangeal joint of the hand

Metacarpophalangeal joint [MCP] dislocations of the index, little and thumb are common; that of the middle finger is very rare. In all the literature consulted only five cases of isolated closed dorsal dislocation of the MCP joint of the middle finger have been reported. Hyperextension of MCP joint is the mechanism of injury. We are herewith reporting a case of isolated MCP dislocation of the middle finger.One of our medical students while driving a motorcycle fell down on the road and sustained lacerated wound over the hypothenar area of the left hand. There was prominence of the head of the third metacarpal on the volar aspect and the base of the proximal phalanx was prominent dorsally. MCP dislocation of the middle finger was our clinical diagnosis which was confirmed by the radiograph. The patient had reported within 60 min of the accident.There was no tendon injury. Wound debridement was done, wound was extended to the back of the middle finger. The volar plate which was interposed between the head of the metacarpal and the base of the proximal phalanx was repositioned and the dislocation was reduced. Reduction was stable and the patient was reviewed after 14 months. The function of the hand is satisfactory.The case is presented for its unique presentation. This is the sixth case of isolated dislocation of the MCP joint of the middle finger.     

钩骨钩骨折的临床分型与治疗

目的 探讨钩骨钩骨折的临床分型,并探讨不同分型的钩骨钩骨折合理的治疗选择.方法 回顾性研究了12例钩骨钩骨折的病例,依据损伤特点和预后将其分为三型:Ⅰ型为钩骨钩尖端的撕脱骨折,Ⅱ型为钩骨钩中段的骨折,Ⅲ型为钩骨钩基底的骨折.依据这一分型,本组病例中Ⅰ型1例、Ⅱ型7例、Ⅲ型4例.其中保守治疗3例,骨折切开复位内固定4例,钩骨钩切除5例;术前合并尺神经损伤3例(2例Ⅱ型,1例Ⅲ型),合并小指指屈肌腱损伤2例(均为Ⅱ型骨折),合并豆三角关节脱位1例(Ⅱ型骨折).重点分析了术后功能恢复情况、恢复时间,以及临床分型与术前并发症和疗效的相关性.结果 本组随访时间为4～16个月,平均(8.4±3.9)个月.进行保守治疗和切开复位内固定7例中有2例Ⅱ型骨折发生骨折不愈合,其他5例骨折均愈合.所有患者至最终随访时均对疗效表示满意或非常满意,其疼痛评分、握力均较术前显著改善.术前并发症经手术治疗均完全缓解.采用钩骨钩摘除术的患者术后恢复时间显著短于其他两种治疗方法.Ⅱ型骨折术前并发症和骨折不愈合的发生率都较其他两型高.结论 钩骨钩骨折的总体疗效是非常令人满意的.对Ⅰ型骨折和无移位的Ⅲ型骨折,可采用保守治疗.对有移位的Ⅲ型骨折,可行切开复位内固定.对Ⅱ型骨折,由于其并发症的发生率较高,应尽早行钩骨钩摘除术.     

Complex volar distal radioulnar joint dislocation occurring in a Galeazzi fracture

The Galeazzi fracture-dislocation of the forearm consists of a transverse or short oblique fracture of the radius at the junction of the middle and distal thirds with an associated subluxation or dislocation of the distal radioulnar joint. Anatomic reduction with rigid internal fixation of the radius typically produces anatomic reduction of the distal radioulnar joint and is the favored treatment. At least three cases of a mechanically blocked distal radioulnar joint requiring open reduction through a separate exposure have been reported. In all three cases there was dorsal displacement of the ulna. We report a case of an irreducible volar dislocation of the distal radioulnar joint following open anatomic reduction of the radius.