Updated: 9/28/2018

Hamate Body Fracture

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https://upload.orthobullets.com/topic/12110/images/oblique.jpg
https://upload.orthobullets.com/topic/12110/images/carpal_fractures.jpg
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https://upload.orthobullets.com/topic/12110/images/hamate.jpg
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https://upload.orthobullets.com/topic/12110/images/ca1211clinchllng2b_214985_214988.jpg
Introduction
  • A rare carpal fracture
  • Epidemiology
    • incidence
      • < 2% of all carpal fractures  
  • Pathophysiology
    • mechanism of injury
      • main cause for these lesions is a direct impact against a hard surface with a clenched fist
  • Associated conditions
    • may be associated with 4th or 5th metacarpal base fractures or dislocations  
      • present in ~ 15%
Anatomy
  • Osteology
    • triangular shaped carpal bone
    • composed of hook and body 
  • Location
    • most ulnar bone in the distal carpal row
  • Articulation
    • 4th and 5th metacarpals
    • capitate
    • triquetrum
Classification

 Milch Classification
Description Subtypes Image
Type I  Hook of hamate fx (most common) 
 • I - avulsion
 • II - middle of hook
 • III - base of hook
  
Type II
 Body of hamate fx
 • IIA - coronal
 • IIB - transverse
 
 
Presentation
  • Symptoms
    • ulnar-sided wrist pain and swelling 
  • Physical exam
    • inspection
      • focal tenderness over hamate  
Imaging
  • Radiographs 
    • recommended views  
      • PA
      • lateral
      • ER oblique
        • best view to see hamate body fractures 
      • carpal tunnel
  • CT 
    • usually required to delineate fracture pattern and determine operative plan  
Treatment
  • Nonoperative
    • immobilization
      • indications
        • rarely may be used for extra-articular nondisplaced fracture
  • Operative
    • ORIF
      • indications
        • most fracture are intra-articular and require open reduction
      • technique
        • interfragmentary screws +/- k-wires for temporary stabilization 
Surgical Techniques
  • Open Reduction Internal Fixation
    • approach
      • dorsal most common approach  
    • fixation technique
      • fixation may be obtained with K wires or screws
    • postoperative care
      • immobilize for 6-8 weeks
Complications
  • Stiffness
  • Malunion
  • Infection
 

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