Palmar Dislocation Fracture of the Hamate: A Case Report and Review of Literature

Abstract

Objective Hamate dislocations are rare lesions of the carpus, which make their diagnosis difficult or even missed, and their management non-standardized.

Case Description We report the case of a 34-year-old victim of a high kinetic traffic accident. The initial evaluation revealed multiple fractures of both upper limbs, including a palmar fracture dislocation fracture of the hamate, without any vascular or nerve complications. Open surgical treatment via a dorsal approach allowed reduction and fixation of the hamate by temporary multiple pinning. At 12-month follow-up the patient had pain free motion of the wrist with a DASH score of 3. Radiographs showed evidence of proximal pole hamate sclerosis and carpo-metacarpal narrowing.

Literature Review Owing to its rarity, literature on this topic is extremity limited. Various mechanisms have been described to explain these injuries, including dorsal pressure on the carpus associated with traction of the annular carpal ligament on its hamate insertion. Symptoms can be minimal and only three cases of nerve complications have been reported. Long-term outcomes following these injuries usually result in decrease in wrist motion and grip strength.

Clinical Relevance The rarity of dislocations with or without hamate fracture favors the absence or the delay of diagnosis, which must lead to a precise radiographic analysis and to the implementation of a CT scan in case of high kinetics carpal trauma, even if it is poorly symptomatic.

Level of Evidence Level 5, case study.

Keywords

Hamate - Dislocation - metacarpal - fracture

Statement

Surgery was performed at the Lapeyronie University Hospital (a) and the patient was followed at the Clinique Saint Jean Sud-de-France (b). The entire management was performed by the corresponding author.

Publication History

Received: 29 August 2022

Accepted: 18 November 2022

Article published online:
11 January 2023

• References

• 1 Arora S, Goyal A, Mittal S, Singh A, Sural S, Dhal A. Combined intraarticular fracture of the body and the hook of hamate: an unusual injury pattern. J Hand Microsurg 2013; 5 (02) 92-95
• 2 Ohshio I, Ogino T, Miyake A. Dislocation of the hamate associated with fracture of the trapezial ridge. J Hand Surg Am 1986; 11 (05) 658-660
• 3 Wang L, Xiong G, Dai L. Dislocation of the hamate and its possible mechanism. J Hand Surg Eur Vol 2013; 38 (05) 556-557
• 4 Wang X, Jia X, Zhang X, Liu B, Zhang Z, Sang H. Isolated complete dislocation of hamate bone with an ulnar nerve injury: a case report and literature review. Ann Transl Med 2022; 10 (06) 385
• 5 D'Utruy A, Siedlecki C, Vallée A, Auquit-Auckbur I. Luxation palmaire de l'hamatum – mécanisme et revue de la littérature: à propos d'un cas. Chir Main 2015; 34: 373
• 6 Pestessy J. [Isolated dislocation of the os hamatum (author's transl)]. Magy Traumatol Orthop Helyreallito Seb 1978; 21 (02) 146-150
• 7 Rosh AJ, Schwartz DT. Isolated capitate and hamate dislocation. J Emerg Med 2012; 42 (06) e151-e152
• 8 Kumar K, Kawas A, Abraham T, de Kesel R. Review of the literature and case report of surgical treatment of a neglected dislocation of hamate. Open J Orthop 2014; 04 (09) 243-248
• 9 Saiz Jr AM, Wuellner JC, Bayne CO. Isolated dislocation of hamate with hook fracture in setting of acute hand compartment syndrome: a case report and review of the literature. J Orthop Case Rep 2020; 10 (08) 76-79
• 10 Garcia-Elias M, Abanco J, Salvador E, Sanchez R. Crush injury of the carpus. J Bone Joint Surg Br 1985; 67 (02) 286-289
• 11 Cha YJ. Changes in the pressure distribution by wrist angle and hand position in a wrist splint. Hand Surg Rehabil 2018; 37 (01) 38-42