OBJECTIVE: To obtain three-dimensional intraosseous artery of the hamate and to provide the vascular anatomy basis of hamate fracture fixation. METHODS: PbO (lead monoxide, Sinopharm Chemical Reagent Beijing Co. Ltd) was ground into particles less than 40 μm and suspended in turpentine oil (Chemical Reagent Beijing Co. Ltd) at ratios of 1 g : 1.5 mL, 1 g : 1 mL and 1 g : 0.5 mL. Three specimens were investigated. Brachial arteries were cannulated and perfused with lead-based contrast agent. Hamates were harvested and scanned using micro-computed tomography (microCT). The acquisition protocols were as follows: CT scan setup: total rotation [Degrees], 360; rotation steps, 360; X-ray detector setup: transaxial, 2048; axial, 2048; exposure time, 1 500 ms, Binning, 1; system magnification: high-med. X-ray tube setup: 80 kV, 500 mA current. The down-sampling factor used in the reconstruction was 2. The effective voxel size of the final image was 27.30 μm. The three-dimensional model of the hamate was generated and the distribution and pattern of vessels were evaluated. RESULTS: There were abundant extraosseous vessels around the hamate. They were mainly running in the tendons and ligaments around the hamate. Four vascular zones were identified on the hamate surface. They were on the palmar platform of the hamate body, on the dorsal side, on the ulnar side and on the tip of hamulus, namely. There were anastomoses among 4 vascular zones. We did not observe any vessels penetrating through the articular cartilage. The extraosseous vessels of the vascular zones gave a number of intraosseous branches into the hamate. The hamate body received intraosseous blood supply from the dorsal, palmar and ulnar while the hamulus from the palmar, ulnar and hamulus tip. There were some intraosseous branches anastomosing with each other. CONCLUSION The extraosseous and intraosseous vessels of the hamate were more than what used to be considered. The hamate body and hamulus received blood supply from multiple directions and arteries anastomosed extensively both outside and inside the hamate, making it possible that the intraosseous perfusion survived after fracture. It is likely that the nonunion after the hamate fracture is not caused by the vascular damage but the malalignment of the fragments.
Beijing ; Brachial Artery ; Fluoroscopy ; Fractures, Bone/diagnostic imaging* ; Hamate Bone/injuries* ; Humans ; Ulna ; Wrist Injuries/diagnostic imaging* ; X-Ray Microtomography

OBJECTIVE: To investigate the relationship between electrodiagnosis and various ultrasonographic findings of carpal tunnel syndrome (CTS) and propose the ultrasonographic standard that has closest consistency with the electrodiagnosis. METHODS: Ultrasonography was performed on 50 female patients (65 cases) previously diagnosed with CTS and 20 normal female volunteers (40 cases). Ultrasonography parameters were as follows: cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the levels of hamate bone, pisiform bone, and lunate bone; anteroposterior diameter (AP diameter) of the median nerve in the carpal tunnel; wrist to forearm ratio (WFR) of median nerve area at the distal wrist crease and 12 cm proximal to distal wrist crease; and compression ratio (CR) of the median nerve. Independent t-test was performed to compare the ultrasonographic findings between patient and control groups. Significant ultrasonographic findings were compared with the electrodiagnosis results and a kappa coefficient was used to determine the correlation. RESULTS: CSA and FR of median nerve at the hamate bone level, CSA of median nerve at pisiform bone level, AP diameter of median nerve within the carpal tunnel, CSA of median nerve at the distal wrist crease and WFR showed significant differences between patient and control groups. WFR showed highest concordance with electrodiagnosis (κ=0.71, p<0.001). CONCLUSION: These findings suggested the applicability of ultrasonography, especially WFR, as a useful adjunctive tool for diagnosis of CTS.
Carpal Tunnel Syndrome* ; Diagnosis* ; Electrodiagnosis* ; Female ; Forearm ; Hamate Bone ; Humans ; Lunate Bone ; Median Nerve ; Pisiform Bone ; Ultrasonography ; Volunteers ; Wrist

PURPOSE: The purpose of this study is to report the clinical results of excision of the hamate hook in baseball players with hamate hook nonunion. MATERIALS AND METHODS: This study included 10 baseball players treated with excision of the hamate hook. Among 10 players, there were 3 professional players and 7 amateur players. The clinical outcomes were evaluated using the visual analog scale (VAS) pain score, exercise performance score, and grip power. We also checked complications and time to return to the game. RESULTS: At final follow-up, the average VAS score was 0.4 points and the average performance score was 9.0 points. The grip power was recovered to 96.7% of the opposite hand at final follow-up. Significant improvement in pain and grip power was observed after surgery. The average time to return to the game was 11.8 weeks. There was one case of postoperative ulnar nerve neuropathy, which was completely resolved within 12 weeks after surgery. CONCLUSION: We think that excision of the hamate hook is an effective treatment to enable early return to the game without loss of grip strength in the baseball player with nonunion of the hamate hook.
Baseball* ; Follow-Up Studies ; Hamate Bone ; Hand ; Hand Strength ; Ulnar Nerve ; Visual Analog Scale

The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain's disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.
Adult ; Fractures, Bone ; diagnostic imaging ; Golf ; injuries ; Hamate Bone ; diagnostic imaging ; injuries ; Humans ; Male ; Tendinopathy ; Tomography, X-Ray Computed ; methods ; Wrist Injuries ; diagnostic imaging

OBJECTIVETo investigate the effcacy of the staple fixation for the treatment of hamate metacarpal joint injury.

METHODSFrom May 2009 to November 2012,16 patients with hamate metacarpal joint injury were treated with staple fixation including 10 males and 6 females with an average age of 33.6 years old ranging from 21 to 57 years. Among them, 11 cases were on the fourth or fifth metacarpal base dislocation without fractures, 5 cases were the fourth or fifth metacarpal base dislocation with avulsion fractures of the back of hamatum. Regular X-ray review was used to observe the fracture healing, joint replacement and position of staple fixation. The function of carpometacarpal joint and metacarpophalangeal joint were evaluated according to ASIA (TAM) system evaluation method.

RESULTSAll incision were healed well with no infection. All patients were followed up from 16 to 24 months with an average of (10.0 +/- 2.7) months. No dislocation recurred, the position of internal fixator was good,no broken nail and screw withdrawal were occurred. Five patients with avulsion fracture of the back of hamatum achieved bone healing. The function of carpometacarpal joint and metacarpophalangeal was excellent in 10 cases,good in 5 cases, moderate in 1 case.

CONCLUSIONThe application of the staple for the treatment of hamatometacarpal joint injury has the advantages of simple operation, small trauma, reliable fixation, early postoperative function exercise and other advantages, which is the ideal operation mode for hamatometacarpal joint injury.

Adolescent ; Adult ; Carpal Joints ; injuries ; surgery ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Hamate Bone ; injuries ; surgery ; Humans ; Male ; Metacarpal Bones ; injuries ; surgery ; Metacarpophalangeal Joint ; injuries ; surgery ; Middle Aged ; Sutures ; utilization ; Young Adult

Scaphoid dislocation is a rare injury. Traditionally it has been classified into isolated dislocation and dislocation associated with axial carpal disruption. We present a unique case of scaphoid dislocation associated with proximal migration of the entire distal carpal row as a single unit and hamate fracture with no axial carpal disruption. This injury complex has not been previously described in the literature. The purpose of this case report is to emphasize that in absence of axial carpal dissociation with scaphoid dislocation, a careful evaluation of injury to other bones should be done and treated accordingly to maximize the chances of favourable outcome with reconstructive surgery.
Fractures, Bone ; complications ; surgery ; Hamate Bone ; diagnostic imaging ; injuries ; Humans ; Male ; Reconstructive Surgical Procedures ; Scaphoid Bone ; diagnostic imaging ; injuries ; Tomography, X-Ray Computed ; Wrist Injuries ; complications ; diagnostic imaging ; surgery ; Young Adult

OBJECTIVE: The purpose of this study was to determine the anatomic relationships between neurovascular structures and the transverse carpal ligament so as to avoid complications during endoscopic carpal tunnel surgery. METHODS: Twenty-eight patients (age range, 35-69 years) with carpal tunnel syndrome were entered into the study. We examined through wrist magnetic resonance imaging in three different positions (neutral, radial flexion, and ulnar flexion) and determined several anatomic landmark (distance from the hamate hook to the median nerve, ulnar nerve, and ulnar vessel) based on the lateral margin of the hook of the hamate. The median nerve and ulnar neurovascular structure were studied with the wrist in the neutral, ulnar, and radial flexion positions. RESULTS: The ulnar neurovascular structures usually passed just over or ulnar to the hook of the hamate. However, in 12 hands, a looped ulnar artery coursed 0.6-3.3 mm radial to the hook of the hamate and continued to the superficial palmar arch. The looped ulnar artery migrates on the ulnar side of Guyon's canal (-5.2-1.8 mm radial to the hook of the hamate) with the wrist in radial flexion. During ulnar flexion of the wrist, the ulnar artery shifts more radially beyond the hook of the hamate (-2.5-5.7 mm). CONCLUSION: It is appropriate to transect the ligament greater than 4 mm apart from the lateral margin of the hook of the hamate without placing the edge of the scalpel toward the ulnar side. We would also recommend not transecting the transverse carpal ligament in the ulnar flexed wrist position to protect the ulnar neurovascular structure.
Anatomic Landmarks ; Carpal Tunnel Syndrome ; Hamate Bone ; Hand ; Humans ; Ligaments ; Magnetic Resonance Imaging ; Median Nerve ; Ulnar Artery ; Ulnar Nerve ; Wrist

Muscular variations of the flexor compartment of forearm are usual and can result in multiple clinical conditions limiting the functions of forearm and hand. The variations of the muscles, especially accessory muscles may simulate soft tissue tumors and can result in nerve compressions. During a routine dissection of the anterior region of the forearm and hand, an unusual muscle was observed on the left side of a 65-year-old male cadaver. The anomalous muscle belly arose from the medial epicondyle approxiamately 1 cm posterolateral to origin of normal flexor carpi ulnaris muscle (FCU), and from proximal part of the flexor digitorum superficialis muscle. It inserted to the triquetral, hamate bones and flexor retinaculum. Passive traction on the tendon of accessory muscle resulted in flexion of radiocarpal junction. The FCU which had one head, inserted to the pisiform bone hook of hamate and palmar aponeurosis. Its contiguous muscles displayed normal morphology. Knowledge of the existence of muscle anomalies as well as the location of compression is useful in determining the pathology and appropriate treatment for compressive neuropathies. In this study, a rare accessory muscle has been described.
Aged ; Cadaver ; Forearm ; Hamate Bone ; Hand ; Head ; Humans ; Male ; Muscles ; Pisiform Bone ; Tendons ; Traction

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.
Adolescent ; Adult ; Follow-Up Studies ; Fractures, Bone ; classification ; surgery ; therapy ; Hamate Bone ; injuries ; surgery ; Humans ; Male ; Retrospective Studies ; Young Adult

OBJECTIVE: To evaluate ultrasonographic change of median nerve and flexor tendon in carpal tunnel after local steroid injection in carpal tunnel syndrome (CTS). METHOD: Thirteen patients (24 hands) with CTS diagnosed clinically and electrophysiologically were included. All subjects were examined by ultrasonography with high-resolution linear array transducer and injected with 40 mg of triamcinolone acetonide. The ultrasonography was evaluated with regard to cross-sectional area and the flattening ratio of the median nerve and cross-sectional area of the flexor pollicis longus tenon at pisiform and hamate bone. After 4 weeks, the patients were re-evaluated with electrophysiologic study and ultrasonography. RESULTS: Most patients (11/13) showed improvement of clinical symptoms and electrophysiologic parameters after the local steroid injection. The cross-sectional area of median nerve at pisiform using ultrasonography significantly decreased after the local steroid injection. However, flexor pollicis longus tendon did not show significant change after the injection. CONCLUSION: Local steroid injection in the patients with CTS caused improvement in ultrasonographic findings of median nerve.
Carpal Tunnel Syndrome ; Hamate Bone ; Humans ; Median Nerve ; Tendons ; Transducers ; Triamcinolone Acetonide