gms | German Medical Science

Objectives/Interrogation: Fractures of the body of the hamate are rare and difficult to diagnose and treat surgically. The radiographic evaluation of the hamate-metacarpal joint is difficult, making its evaluation with a CT Scan necessary.

In this kind of fractures it is necessary to reconstruct the articular surface of the joint to minimize the post-traumatic complications like painful posttraumatic osteoarthritis.

Methods: The authors present a clinical case of a fracture of the body of the hamate treated surgically with an arthroscopic approach.

Case Report: We present a case of a 36 year-old male with a complex fracture of the body of the hamate (Type II of Milch's classification) after a high energy fall. The articular CT Scan revealed an impacted osteochondral fragment and one dorsal fragment.

According to the characteristics of the fracture (that presented a split depression fragment) we opted to do the fracture fixation with an arthroscopic approach. We used the vertical traction tower and two dorsal arthroscopic portals that allowed the elevation of the osteochondral fragment with the arthroscopic probe. We opted to stabilize the small dimension fragments with two percutaneous K wires with the aid of fluoroscopy. The patient used a splint for 5 weeks and was then assigned a specific physical rehabilitation program. At this moment, 6 months after surgery, the patient is completely recovered, having no limitations in its physical activity. He has a Visual Analogue Scale score of 0 and recovered is grip strength completely.

Conclusion: The arthroscopic approach in this complex fracture of the body of the hamate was an excellent option to avoid the surgical aggression and the complications of an open procedure while allowing a good reduction of the osteochondral fragment with a magnified view.