Surgical treatment of coronal plane hamate fractures: Clinical and radiological outcomes

In this study, we present our extensive case series on hamatometacarpal fracture-dislocations treated with open reduction and internal fixation and share our treatment strategies and outcomes.

Between March 2014 and November 2022, a total of 17 male patients (mean age: 28.6±7.9 years; range, 18 to 49 years) with isolated hamate fracture or a fracture involving the base of the fourth and/or fifth metacarpals who underwent surgery and were followed for a minimum duration of 12 months were retrospectively analyzed. Mechanism of injury, type of hamate fracture, presence of associated metacarpal fracture-dislocations, demographic data, time to surgery, postoperative duration of immobilization and complications were noted. Functional assessment was performed using Disabilities of the Arm, Shoulder, and Hand (DASH) scoring and grip strength was evaluated using a hand dynamometer.

The mean follow-up was 5.8±2.2 (range, 2 to 8) years. All patients were male, with fractures on the dominant side, and the primary mechanism of injury was punching a hard surface. Surgical fixation primarily involved a single screw, with Kirschner wires used for metacarpal stabilization. The mean time to return to work was 61±22 (range, 35 to 90) days. The mean grip strength of the injured and uninjured side was 40.5±3.6 kg and 42.1±3.5 kg, respectively (p=0.415). The mean DASH score at the final follow-up was 5.6±4.8. All patients achieved clinical union, with no malunions, and full range of motion was restored. Two cases of ulnar nerve neuropraxia fully resolved.

The surgical treatment of coronal plane hamate fractures associated with the fourth and fifth metacarpal base fracture-dislocations can provide good functional recovery in these complex fractures.