SIMULTANEOUS FRACTURE OF THE HOOK OF THE HAMATE AND FOURTH CARPOMETACARPAL JOINT: CASE REPORT

Abstract Introduction: Evidence of a fourth carpometacarpal joint dislocation and hamate fracture is rare, which may be due to its difficult and sometimes missed diagnosis based on routine X-rays. A simultaneous fracture of the hamate and carpometacarpal joint dislocation in the same hand is extremely rare. We report a case of a combination of a fourth carpometacarpal joint dislocation and a fracture of the hook of the hamate detected by computer tomography (CT) imaging. Case Presentation: The patient was a 32-year-old right-hand-dominant man, with a chief complaint of right-hand pain, especially in the fourth and fifth fingers, which began immediately after punching a handle of an armchair. On physical examination, there was a deformity and tenderness with reduced range of movement (ROM) on the fourth metacarpal. Radiographs showed a dislocation of the fourth carpometacarpal joint and a suspicious fracture in the hook part of the hamate. Then, the patient underwent a CT image that indicated a dislocation of the fourth carpometacarpal joint and a fracture in the hook of the hamate. An open reduction and internal fixation (ORIF) was done, and the wrist and hand were immobilised for six weeks. At three months’ follow-up, the patient had normal strength in his hand, and he was asymptomatic. Conclusion: Hamate fracture is often missed on initial presentation and initial X-ray, which emphasises the need for compulsive diagnostic evaluation such as CT imaging and careful follow-up. In fact, when there is a tenderness, and a reduced ROM on the base of fourth carpometacarpal joints, CT is helpful in a more accurate diagnosis.