Classiifcation and treatment of fractures of the body of the hamate

GAO Yong-bin; TIAN Guang-lei; YIN Yao-bin

doi:10.3969/j.issn.2095-252X.2014.03.002

Abstract：Objective To investigate the clinical classiifcation and therapeutical strategy of fractures of the body of the hamate. Methods The clinical classiifcation and therapeutic effects of 41 cases of fractures of the body of the hamate were reported. The fractures of the body of the hamate were classiifed into 2 major groups and 3 subgroups based on the orientation of the fracture line and the effects on the stability of the hamatometacarpal joint. Type I referred to the traverse fracture, and type II referred to the longitudinal fracture. Type II A represented coronal splitting fractures of the hamate, type II B represented oblique fractures with a major part of the dorsal hamate joint involved, and type II C represented avulsion fractures of the dorsal hamate. There were 2 cases of type I, 9 cases of type II A, 21 cases of type II B and 9 cases of type II C in this group. The therapeutical strategy was chosen based on the type of fractures, and the conservative treatment was performed on 6 patients and the operative treatment on 35 patients. Results The average follow-up period was ( 21.2±12.2 ) months ( range;4-48 months ). Subjective evaluations of the patients were good or excellent in the latest follow-up. The fracture union rate was 100%. The mean grip strength of the affected hand and the unaffected hand was ( 40.41±6.18 ) kg and ( 40.26±5.13 ) kg respectively there were no signiifcant differences between bilateral hands in the postoperative grip strength ( P=0.613 ). No complications such as infection, tendon adhesion or nerve injuries were noticed. Conclusions The prognosis of fractures of the body of the hamate is good. The patients with type II A and II B fractures should be treated with operation because of the bad stability. Whether the patients with type II C fractures should be treated with operation or not depends on the combined injuries and the stability after the reduction of the carpometacarpal joint.