Patient presented to emergency after an altercation with a plane glass window, deep laceration to the hand and heavily intoxicated.
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There are obvious soft tissue injuries over the dorsal aspect of the second and fifth metacarpal heads; also there is gas present as a result of the open wound.
Fracture of the dorsal aspect of the hamate.
Hamate fractures account for 2-4% of carpal bone fractures 1-3. The hamate fracture is a commonly missed fracture due to the complexity of the anatomy of the carpal bone area and in this case 2, other distracting injuries associated with it.
There exist two pertinent factors that could have potentially delayed the diagnosis of the fracture mentioned above:
- significant soft tissue damage acting as a distraction injury for both the patient and the attending team
- intoxication and unwillingness to specify the source of pain
This case is an excellent example of the value in 'parking' the obvious deformity and continuing to examine all areas of the radiograph.
- 1. Snoap T, Habeck J, Ruiter T. Hamate Fracture. Eplasty. 2015;15: ic28. Free text at pubmed - Pubmed citation
- 2. Goliver JA, Adamow JS, Goliver J. Hamate body and capitate fracture in punch injury. Am J Emerg Med. 2014;32 (10): 1303.e1-2. doi:10.1016/j.ajem.2014.03.050 - Pubmed citation
- 3. Hirano K, Inoue G. Classification and treatment of hamate fractures. Hand Surg. 2005;10 (02n03): 151-7. doi:10.1142/S0218810405002747 - Pubmed citation