Fracture of the Body of the Hamate With Dorsal Dislocation of the 4th and 5th Metacarpals: A Case Report

Abstract

Background: Solitary fractures of the body of the hamate are rare. Their diagnosis is difficult and requires a high clinical suspicion and a proper radiological examination.

Case report: We present a case of a 36-year-old male patient who sustained an intraarticular fracture of the body of the hamate along with dorsal dislocation of the 4^th and 5^th metacarpals on his right dominant hand. Through a dorsal surgical approach, he underwent ORIF of the hamate with screws and stabilization of the dislocated 4^th and 5^th metacarpals with KW. At his last follow-up appointment, 18 months postoperatively, he had no pain, almost full range of motion on his fingers and a Mayo Wrist score of 90 points.

Conclusions: Hamate fractures are rare entities that can cause significant patient morbidity if not recognized and treated appropriately.

Keywords: Dorsal dislocation; Fracture; Hamate body; Internal fixation; Metacarpals; Missed injury.

Fig. (1)

(a) Oblique 30o X-ray of the injured wrist showing dislocation of the 4th and 5th metacarpals. (b) CT scan showing the fracture of the hamate body, (c) clinical photo of the wrist showing diffuse swelling over the lesser metacarpals, (d) anteroposterior intraoperative (C-arm) X-ray showing fixation of the hamate with 2 small screws and reduction of the CMC dislocation with 2 KW, (e, f) anteroposterior and oblique X-rays of the wrist at 18 months showing healing of the hamate and congruent hamatometacarpal joint and (g) clinical photos of the wrist showing good range of motion and grip at the latest follow up.