Hand Swelling due to Missed Coronal Fracture of the Body of the Hamate and Hamate-Triquetral Dislocation

Case Report

Hand Swelling due to Missed Coronal Fracture of the Body of the Hamate and Hamate-Triquetral Dislocation

M Sajjad Athar^*, Zamfir Georgiana Dana, Neil Ashwood and Christos Kitsis
Department of Trauma and Orthopaedics, Queen’s Hospital, UK

^*Corresponding author: Mohammad Sajjad Athar, Department of Trauma and Orthopaedics, Queen’s Hospital, Belvedere Road, Burton upon Trent, DE13 0RB, UK

Published: 18 Oct, 2016
Cite this article as: Sajjad Athar M, Georgiana Dana Z, Ashwood N, Kitsis C. Hand Swelling due to Missed Coronal Fracture of the Body of the Hamate and Hamate- Triquetral Dislocation. Ann Clin Case Rep. 2016; 1: 1157.

Abstract

Post trauma hand swelling needs in-depth examination and imaging to diagnose fracture dislocations. High index of suspicion is needed to diagnose unusual pattern of fracture. Early diagnosis of hamate fracture dislocation is helped by CT examination, and early treatment of these injuries result in satisfied patients with good functional outcomes.

Introduction

Fracture of the body of Hamate is classically caused either by a direct blow or crush injury. Sometimes often confused with Hamulus proprium which represent an ossification centre that has failed to fuse, but Coronal fractures of the body of the hamate are extremely uncommon and can easily be missed. Hamate-triquetral dislocation is even rarer.

Case Presentation

We present the case of a 20 year old right handed man who attended the A&E department with ulnar sided left wrist pain after a fall abroad the previous week to presentation. Examination and X-rays at the presentation time were inconclusive but at the fracture clinic he was tender over the hamate (Figure 1). A CT scan showed coronal fracture of the hamate with hamate-triquetral dislocation (Figure 2). Closed reduction of the hamate-triquetral and stabilisation with K-wire from the 5th to 3rd metacarpal was performed. The fracture was fixed dorsally with a 3-hole 2.0 mm plate. At 3 weeks wires and cast were removed and hand therapy initiated (Figure 3 and 4). After 6 months the plate was removed. Two months post plate removal the patient returned to work and was discharged.

Figure 1

Figure 1
Pre operative X-rays.

Figure 2

Figure 2
Pre operative CT scan.

Discussion

Normally a hamate fracture can be identified in a PA view of the wrist. A fracture of hook of hamate can be seen a carpal tunnel view or in a supination oblique view. It is extremely difficult to look and identify a coronal fracture of hook of hamate in routine radiographs. CT is the best way to diagnose these fractures. Coronal fractures of the hamate are so rare that they are not included in Milch’s classification [1]. Ebraheim et al. [2] described 3 patterns of coronal fractures of the hamate. Although Lunotriqutral dislocation is known Hamate triquetral dislocation is almost unknown. In fact there is only one paper which has cited the combination of fracture of hamate with dislocation of hamatetriquetral as it is extremely rare [3].

Figure 3

Figure 3
Post operative X-rays.

Figure 4

Figure 4
Post operative X-rays after removing K-wire.

Conclusion

There are variety of causes and differential diagnosis for ulnar sided wrist pain. A fracture of hamate is one of them so it should always be looked at. Pain and deformity of the ulnar side of carpus with inconclusive radiographs must lead to the suspicion of hamate injuries [4]. A CT scan is almost the investigation of choice in these circumstances. When diagnosed early and treated promptly they end up in favourable outcome.

Case Report