Multiple flexor tendon ruptures due to osteochondroma of the hamate:A case report

BACKGROUND Closed rupture of the little and ring finger flexor tendons caused by the hamate is mostly associated with a fracture or nonunion of the hamate hook.Only one case of a closed rupture of the finger flexor tendon caused by osteochondroma in the hamate has been reported.Here,we present a case study to highlight the possibility of hamate osteochondroma as a rare cause of finger closed flexor tendon rupture based on our clinical experience and literature review.CASE SUMMARY A 48-year-old man who had been a rice-field farmer for 7–8 h a day for the past 30 years visited our clinic due to the loss of right little finger and ring finger flexion involving both the proximal and distal interphalangeal joints.The patient was diagnosed with a complete rupture of the ring and little finger flexors because of the hamate and was pathologically diagnosed with an osteochondroma.Exploratory surgery was performed,and a complete rupture of the ring and little finger flexors due to an osteophyte-like lesion of the hamate was observed,which was pathologically diagnosed as an osteochondroma.CONCLUSION One should consider that osteochondroma in the hamate may be the cause of closed tendon ruptures.

Clinical Classification and Treatment Strategy of Hamate Hook Fracture

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures,12 patients who suffered from hamate hook fractures were followed up retrospectively.According to the fracture sites and the prognosis,we classified the hamate hook fractures into 3 types.Type Ⅰ referred to an avulsion fracture at the tip of hamate hook,type Ⅱ was a fracture in the middle part of hamate hook,and type Ⅲ represented a fracture at the base of hamate hook.By the classification,in our series,only 1 fell into type Ⅰ,7 type Ⅱ,and 4 type Ⅲ.The results were evaluated with respect to the functional recovery,recovery time and the association among the clinical classification,pre-operative complications and treatment results.The average follow-up time of this group was 8.4±3.9 months.Two cases were found to have fracture non-union and both of them were type Ⅱ fractures.Six patients had complications before operation.Five cases were type Ⅱ fractures and 1 case type Ⅲ fracture.All the patients were satisfied with the results at the time of the last follow-up.Their pain scale and grip strength improved significantly after treatment.All the pre-operative complications were relieved.The recovery time of hamate hook excision was significantly shorter than that of the other two treatments.The incidences of both pre-operative complications and non-union in type Ⅱ fractures were higher than those in type Ⅰ and type Ⅲ fractures.It was concluded that,generally,the treatment effects with hamate hook fracture are quite good.The complication incidence and prognosis of the fracture are closely related to the clinical classification.Early intervention is critical for type Ⅱ fractures.

Review of the Literature and Case Report of Surgical Treatment of a Neglected Dislocation of Hamate

Introduction: Hamate dislocation is an uncommon injury, and there are only 17 reported cases in the literature. Ten of them are isolated injuries, and in 7 cases the hamate dislocation is a part of other injuries of the hand. Hamate dislocation can be caused by both direct and indirect forces, or as a part of complex injury of the wrist and hand. Case Report: A case report of a 26-year-old man who presented with a machine injury to his hand with a volar hamate dislocation which was initially missed in the Emergency department as a volar lacerated wound of the hand and was subsequently discovered in the Orthopaedic clinic 6 weeks later. Conclusion: This is only the second report in literature of a neglected hamate dislocation being surgically treated and the 18th reported case of a hamate dislocation over the last 130 years. The direction of dislocation depends on the direction of force applied. Surgical treatment with fixation is optimal even for neglected cases. There was no incidence of avascular necrosis of hamate reported, reflecting the almost equal volar and dorsal blood supply of the hamate.

Minimally invasive method to treat a rare wrist injury with simultaneous fractures of the scaphoid and hook of hamate: A case report and literature review

Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus much more challenging for a hand surgeon or orthopedist. Minimally invasive percutaneous internal fixation is an optimal treatment with the potential to minimize injury and reduce fractures. However, the control of iatrogenic injuries, including possible damage to the adjacent vital tissue, is a challenge that needs to be addressed. Herein,we describe the case of a 26-year-old man who presented with fractures to the scaphoid and hook of hamate in his left wrist. Minimally invasive treatment-with closed reduction and percutaneous fixation of the scaphoid, wrist arthroscopy, and closed reduction and percutaneous fixation of the hook of hamate-was performed at our institution. The Mayo score of the wrist, visual analog scale(VAS) for pain, grip strength, pinch strength, and wrist motion in radial/ulnar and flexion/extension deviation were recorded. Primary healing was achieved in both fractures. At the final follow-up, the Mayo score of the wrist was 100(excellent), the VAS score was 0(no pain),and the grip and pinch strength of his injured hand were 90.9% and 83.3%, respectively, compared with the contralateral hand(grip strength: left, 50 kg;right, 55 kg. Pinch strength: left, 20 kg;right, 24 kg). The radialulnar, flexion-extension, and forearm pronation-supination directions were 30°, 140°, and 90°, respectively.Minimally invasive closed reduction with percutaneous internal fixation is an optimal technique with satisfactory outcomes for simultaneous fractures of the hook of hamate and scaphoid. Provided in this paper are details of the technique and technical suggestions for performing the procedure.

Features of intra-hamate vascularity and its possible relationship with avascular risk of hamate fracture

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.