Minimally invasive method to treat a rare wrist injury with simultaneous fractures of the scaphoid and hook of hamate: A case report and literature review

Abstract

Concomitant fractures of the hook of hamate and scaphoid are rare injuries to the wrist. Whenever these fractures cannot be effectively managed, nonunion or osteonecrosis is encountered. Subsequent treatment is thus much more challenging for a hand surgeon or orthopedist. Minimally invasive percutaneous internal fixation is an optimal treatment with the potential to minimize injury and reduce fractures. However, the control of iatrogenic injuries, including possible damage to the adjacent vital tissue, is a challenge that needs to be addressed. Herein, we describe the case of a 26-year-old man who presented with fractures to the scaphoid and hook of hamate in his left wrist. Minimally invasive treatment—with closed reduction and percutaneous fixation of the scaphoid, wrist arthroscopy, and closed reduction and percutaneous fixation of the hook of hamate—was performed at our institution. The Mayo score of the wrist, visual analog scale (VAS) for pain, grip strength, pinch strength, and wrist motion in radial/ulnar and flexion/extension deviation were recorded. Primary healing was achieved in both fractures. At the final follow-up, the Mayo score of the wrist was 100 (excellent), the VAS score was 0 (no pain), and the grip and pinch strength of his injured hand were 90.9% and 83.3%, respectively, compared with the contralateral hand (grip strength: left, 50 kg; right, 55 kg. Pinch strength: left, 20 kg; right, 24 kg). The radial-ulnar, flexion-extension, and forearm pronation-supination directions were 30°, 140°, and 90°, respectively. Minimally invasive closed reduction with percutaneous internal fixation is an optimal technique with satisfactory outcomes for simultaneous fractures of the hook of hamate and scaphoid. Provided in this paper are details of the technique and technical suggestions for performing the procedure.

Keywords

• Scaphoid fracture
• Hook of hamate fracture
• Carpal fracture
• Minimally invasive treatment