Arch Hand Microsurg.  2022 Sep;27(3):193-202. 10.12790/ahm.22.0023.

Operative treatment of hamate fractures with hamatometacarpal fracture dislocation using a self-designed dorsal buttress locking plate with trans-metacarpal pin insertion: short-term follow-up results

• Kim SW
• Lee HJ
• Park JK
• Chung DM

• KMID: 2532734
• DOI: http://doi.org/10.12790/ahm.22.0023

Abstract

Purpose
Fracture and dislocation of the hamatometacarpal joint are rare; therefore, the diagnosis is frequently missed and the treatment is not clearly established. The authors performed operative treatment of hamate fractures with hamatometacarpal fracture dislocation using a self-designed dorsal buttress locking plate. Herein, we report the clinical and radiological results.
Methods
From May 2016 to February 2022, we experienced 12 cases of hamatometacarpal fracture dislocation that underwent operative treatment with a self-designed dorsal buttress locking plate. All 12 patients were male, with an average age of 30.3 years and an average postoperative follow-up period of 6 months and 1 week. Open reduction and internal fixation were performed using a self-designed dorsal buttress locking plate with trans-metacarpal pin insertion according to the patient, and the results of the treatment were evaluated radiologically and clinically.
Results
All cases showed bony union in radiological evaluations at the last follow-up. In functional evaluations using the modified Mayo wrist score, the results were excellent in 11 cases and good in 1 case. There were no complications such as fixation failure, nonunion, or infection.
Conclusion
In cases of hamate fracture with hamatometacarpal fracture dislocation, the dorsal displaced fragment is very small, and it is often difficult to maintain reduction by direct fixation. In these fractures, operative treatment using a self-designed dorsal buttress locking plate with trans-metacarpal pin insertion can obtain good results.

Keyword

Hamate fracture; Hamatometacarpal joint fracture dislocation; Locking plate

Figure

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  Fig. 1. Photographs showing self-designed metal plates cut and deformed by existing metal plates. (A) 2.0-mm Arix hand plate (Jeil Medical, Seoul, Korea). (B, C) 2.0-mm Synthes Compact Hand LCP (Depuy Synthes, Oberdorf, Switzerland).

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  Fig. 2. Photographs showing three-dimensional computed tomography scans of the hamate and the recommended position of the self-designed dorsal buttress locking plate.

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  Fig. 3. Preoperative plain radiographs (A, anteroposterior view; B, lateral view) of a 19-year-old male patient injured by a fall onto the floor. The radiographs show fracture and dislocation of the hamatometacarpal joint (arrows).

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  Fig. 4. Three-dimensional (3D) computed tomography scan (A and B, sagittal view; C, axial view; D, 3D image) showing displaced fracture dislocation of the hamatometacarpal joint (arrows).

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  Fig. 5. Postoperative plain radiographs (A, anteroposterior view; B, lateral view) at 4 weeks after open reduction and internal fixation with a self-designed dorsal buttress locking plate (arrows) and with intermetacarpal Kirschner-wire insertion. The radiographs show good reduction status.

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  Fig. 6. Preoperative plain radiographs (A, anteroposterior view; B, oblique view) of a 24-year-old male patient injured by punching a wall, showing fracture and dislocation of hamatometacarpal joint (arrows).

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  Fig. 7. Three-dimensional computed tomography scan (A & B, sagittal view; C, axial view; D, Three-dimensional image) showing displaced fracture dislocation of the hamatometacarpal joint (arrow).

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  Fig. 8. Postoperative plain radiographs (A, anteroposterior view; B, oblique view) at 4 weeks after open reduction and internal fixation with a self-designed dorsal buttress locking plate (arrow) and with intermetacarpal Kirschner-wire insertion. The radiographs show good reduction status.

Reference

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