Arch Hand Microsurg.  2021 Dec;26(4):245-253. 10.12790/ahm.21.0121.

Screw Fixation Method through Temporary Kirschner Wire Hole for Coronal Hamate Fracture

• Jo YG
• Lee Y
• Lee J
• Bae KJ
• Kim MB
• Lee YH

• KMID: 2522622
• DOI: http://doi.org/10.12790/ahm.21.0121

Abstract

Purpose
Hamate coronal body fracture is a rare injury and often associated with dislocation of the carpometacarpal joint. For preserving the carpometacarpal joint, open reduction and rigid internal fixation is needed to displaced fracture. The purpose of this study was to evaluate the outcome of treating hamate coronal fracture with the screw fixation method through a temporary Kirschner wire (K-wire) fixation hole.
Methods
From August 2016 to January 2021, eight patients who had displaced coronal hamate body fractures were enrolled. All patients were performed open reduction and multiple K-wires fixations. After that, the cortical screws were then inserted directly into the holes made by removing the K-wires one by one. The outcome measures were Disabilities of the Arm, Shoulder and Hand (DASH) scores and visual analogue scale (VAS) scores.
Results
The average follow-up period was 11.5 months (range, 5–8 months) after surgery, and the bone union was observed at the 8 weeks after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that the average DASH score was 3.95 (range, 0–8.3) and VAS score was 0.8 (range, 0–3).
Conclusion
In coronal hamate body fractures, open reduction and screw fixation method through temporary K-wire fixation hole is simple and effective treatment technique.

Keyword

Hamate bone; Fracture; Bone screws

Figure

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  Fig. 1. A 41-year-old male patient injured by a punch machine complained of hand ulna side pain and swelling. (A) A plain radiograph showed coronal hamate body fracture. (B) Especially, it was well seen on the 30° pronation view. Computed tomography also showed coronal hamate body fracture in sagittal (C) and axial (D) view.

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  Fig. 2. Intraoperative medial photos and C-arm images. (A) Through dorsal approach, incised skin in a zigzag shape and joint capsule in the inverted ‘S’ shape. (B) Using a reduction clamp, hamate coronal fracture was reduced. (C, D) Temporary fixation was done with multiple Kirschner wires (K-wires). (E, F) K-wire from hamate body to hook was removed and in situ fixation with a cortical screw. (G, H) After that, temporary K-wires were removed.

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  Fig. 3. Similarities between drill bits and Kirschner-wires (K-wires). (A) The 2.0-mm screw drill bit is 1.5 mm, similar to 1.6-mm K-wire. (B) The 1.5-mm screw drill bit is 1.1 mm and has the same thickness as the 1.1-mm K-wire.

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  Fig. 4. Postoperative radiographs. (A, B) Immediate postoperative plain radiographs after open reduction and internal fixation with cortical screw for hamate body fracture. (C, D) Immediate computed tomography showed an appropriate length of cortical screw but mild gapping of the fracture site.

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  Fig. 5. Postoperative plain radiograph at 8 weeks after surgery showed successfully reduced fragments using cortical screw.

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