Hamate Metacarpal Fracture Dislocation. Presentation of Four Cases and Literature Review

Abstract

Metacarpal hamate fractures and dislocations comprise a wide range of rare, complex injuries. Their most common cause is hitting solid objects with the fist or sustaining high-energy traumas. The clinical picture consists of pain and swelling in the proximal ulnar side of the hand. Imaging, especially posteroanterior, oblique (30 and 60 degrees), and lateral radiographs, reveals fractures and dislocations, providing a definite diagnosis. Ideally, a computed tomography scan should complement imaging. Treatment is often surgical. Fixation may be percutaneous for optimal closed reduction, but with a low threshold for open reduction using Kirschner wires, screws, or plates to reduce the risk of malunion, post-traumatic osteoarthritis, and chronic pain. We present four patients with an average follow-up of 38 months who underwent surgical treatment in the same medical center, with excellent functional outcomes and mean Disabilities of the Arm, Shoulder, and Hand (DASH) score of 9 points. We also synthesized the available evidence to guide the management of a low-frequency injury with significant prognostic implications.

Keywords

metacarpal hamate fracture dislocation - fourth and fifth carpometacarpal - hamate fracture

Publication History

Received: 17 January 2022

Accepted: 03 October 2023

Article published online:
30 October 2023

• Referencias

• 1 Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br 1987; 69 (02) 212-214
• 2 Ranney D. The hand as a concept: digital differences and their importance. Clin Anat 1995; 8 (04) 281-287
• 3 El-Shennawy M, Nakamura K, Patterson RM, Viegas SF. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg Am 2001; 26 (06) 1030-1035
• 4 Bhardwaj P, Sivakumar BS, Vallurupalli A, Pai M, Sabapathy SR. Fracture dislocations of the carpometacarpal joints of the fingers. J Clin Orthop Trauma 2020; 11 (04) 562-569
• 5 Cain Jr JE, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg Am 1987; 12 (5 Pt 1): 762-767
• 6 Kato J, Tsujii M, Kitaura Y, Sudo A. Surgical Treatment for Delayed Ulnar Carpometacarpal Fracture-Dislocations. J Wrist Surg 2020; 9 (03) 235-239
• 7 Kim JK, Shin SJ. A novel hamatometacarpal fracture-dislocation classification system based on CT scan. Injury 2012; 43 (07) 1112-1117
• 8 Verhiel SHWL, Knaus WJ, Simeone FJ, Mudgal CS. Carpometacarpal 4/5 Fracture Dislocations: Fracture Morphology and Surgical Treatment. J Hand Microsurg 2020; 12 (Suppl. 01) S21-S27
• 9 Snoap T, Habeck J, Ruiter T. Hamate Fracture. Eplasty 2015; 15: ic28
• 10 Milch H. Fracture of the hamate bone. J Bone Jt Surg 1934; 16 (02) 459-462
• 11 Langenhan R, Hohendorff B, Probst A. Koronare Spaltluxationsfrakturen des Os hamatum und der Os metakarpale IV-Basis: eine seltene Form der karpometakarpalen Verletzung. Handchir Mikrochir Plast Chir 2011; 43 (03) 140-146
• 12 Yoshida R, Shah MA, Patterson RM, Buford Jr WL, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am 2003; 28 (06) 1035-1043
• 13 Schortinghuis J, Klasen HJ. Open reduction and internal fixation of combined fourth and fifth carpometacarpal (fracture) dislocations. J Trauma 1997; 42 (06) 1052-1055
• 14 Dahlin L, Palffy L, Widerberg A. Injury to the deep branch of the ulnar nerve in association with dislocated fractures of metacarpals II-IV. Scand J Plast Reconstr Surg Hand Surg 2004; 38 (04) 250-252
• 15 Peterson P, Sacks S. Fracture-dislocation of the base of the fifth metacarpal associated with injury to the deep motor branch of the ulnar nerve: a case report. J Hand Surg Am 1986; 11 (04) 525-528
• 16 Johnson J, Fowler J, Costello J, Ruppert K, Kaufmann R. Optimal Oblique Radiographs to Identify Fifth Carpometacarpal Dorsal Subluxations: A Cadaveric Study. J Hand Surg Am 2018; 43 (12) 1139.e1-1139.e5
• 17 Cano Gala C, Pescador Hernández D, Rendón Díaz DA, López Olmedo J, Blanco Blanco J. 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. Int J Surg Case Rep 2013; 4 (05) 442-445
• 18 Fuller JB, Piscoya AS, Clark DM, Markose K, Dunn JC. Surgical Management of Ulnar Metacarpal Base Fracture-Dislocations: A Systematic Review. Hand (N Y) 2022; 17 (03) 405-411
• 19 Sangole AP, Levin MF. Arches of the hand in reach to grasp. J Biomech 2008; 41 (04) 829-837
• 20 Lawlis III JF, Gunther SF. Carpometacarpal dislocations. Long-term follow-up. J Bone Joint Surg Am 1991; 73 (01) 52-59
• 21 Meunier MJ, Hentzen E, Ryan M, Shin AY, Lieber RL. Predicted effects of metacarpal shortening on interosseous muscle function. J Hand Surg Am 2004; 29 (04) 689-693
• 22 Yang Y, Scheker LR, Kumar KK. Arthroplasty for fifth carpometacarpal joint arthritis. J Wrist Surg 2015; 4 (02) 110-114
• 23 Zribi W, Zribi M, Jemaa MB. et al. Arthrose post-traumatique carpo-métacarpienne du cinquième doigt traitée par arthroplastie stabilisée: à propos de deux cas et revue de la littérature. Pan Afr Med J 2018; 30: 163
• 24 Dubert T. Arthroplastie stabilisée du cinquième métacarpien Proposition thérapeutique pour le traitement des fractures-luxations anciennes du 5ème métacarpien. Ann Chir Main/ Ann . Hand Surg 1994; 13 (05) 363-365