First reported case of a coronal hamate fracture associated with intrusion of the fifth metacarpal base, together with a fracture of the fourth metacarpal base

We present a case reporting a rare combination of base of fourth metacarpal fracture and coronal body of hamate fracture, treated conservatively with excellent results. High index of suspicion for undetected bony injuries drove the execution of a CT scan, which allowed us to make a full correct diagnosis and plan treatment. Moreover, this case becomes the first reported case in the literature of such injury causing the intrusion of the base of the fifth metacarpal within the hamate bone, thus causing the coronal pattern of the hamate fracture. Differently from the common surgical management of this type of injury, we successfully treated this patient with close reduction and immobilisation, with full recovery after 3 months.

Capitate and Hamate Fracture. Case Study

Capitate and hamate fractures are infrequent injuries and are uncommon in isolation. A capitate fracture is usually associated with a scaphoid fracture. The primary mechanism of injury is a fall with the wrist in hyperextension. Other possible ways for capitate fractures are axial down trauma of the third metacarpal and direct trauma. Hamate fractures have a 2% incidence among carpal bone fractures, probably due to underreporting. They can occur on the hamate body or the hamulus or hook. Combined capitate and hamate fractures are uncommon and relevant studies, especially case reports, are scarce. We present a case report of a combined capitate and hamate fracture in a 44-year-old patient who suffered a direct trauma to the back of the hand during a fall. Following a clinical suspicion based on history and physical examination, radiographic and computed tomography (CT) studies were crucial for elucidating the case and proposed treatment, which involved ensuring absolute stability and performing an open reduction, using interfragmentary compression, with the Herbert bone screw implanted in each bone. After the surgical procedure, the patient wore a forearm plaster cast splint for four weeks. A satisfactory outcome was obtained in three months, with a complete range of motion and preserved force compared to the contralateral hand.