Narrow Results

Pisiform and hamate coalition is a rare anomaly of the carpal bones; a symptomatic case is an especially rare condition. We report a case of symptomatic pisiform and hamate coalition in a 15-year-old Japanese male. The literature of pisiform and hamate coalition is reviewed.

The case of a 25-year-old man with osteonecrosis of the hamate is reported. He had pain and swelling in his right wrist. The diagnosis was accomplished with plain radiographs as well as with MRI. The case was treated surgically that included resection of the necrotic bone. The occured cavity was filled with autogenous cancellous bone graft. In addition, capito-hamate arthrodesis was performed. Histopathological examination following the operation demonstrated avascular necrosis of the hamate. The arthrodesis was obtained four months after the operation.

A case of simultaneous fracture of the waist of the scaphoid and the hook of the hamate is presented. The scaphoid fracture was treated surgically with a headless compression screw, while the hook fracture was treated conservatively with cast immobilisation for eight weeks. Both fractures achieved bone union and the patient returned to work without any symptoms or complications.

Only two cases of fractures of the scaphoid and hamate have been reported previously. However, both of them involved fracture of the body of the hamate. This is the first report of simultaneous fracture of the scaphoid and the hook of the hamate.

Background: We devised a new classification of hamate fractures named the TOUCH classification. Each letter of this acronym depicts a fracture type – Type I (Transverse fracture), Type II (Open and/or complex fracture), Type III (Ulnar/medial tuberosity fracture), Type IV (Coronal fracture) and Type V (Hook fracture). Each fracture type was further divided into two or three subtypes (a, b, and/or c) based on degree of severity. The aim of this study is to classify the hamate fractures treated at our centre using this classification.

Methods: A retrospective review of all patients with hamate fractures treated at our hospital between 2003 and 2022 was done. Patient data with regard to age, gender, mechanism of injury, injured limb and any associated injuries was collected. Hamate fractures were classified based on the TOUCH classification.

Results: A total of 247 patients with hamate fractures were included. Patients in the age group of 20–40 years accounted for 73.6% of all fractures. Female patients accounted for only 6.9% of all fractures and 76.5% of women with hamate fractures were older than 40 years. The incidence of hamate fracture tended to increase with age in women. The most common mechanism of injury was a fall (69 patients). The injury involved the right upper limb in 195 patients. And 164 patients had associated injuries in the same upper limb. Type III (coronal fracture of the hamate body) accounted for 57.4%, followed by type V (hook of hamate fracture) in 26.7% of patients.

Conclusions: The TOUCH classification could cover all kinds of hamate fractures. It is easy to remember and may guide surgeons in considering treatment options.

Level of Evidence: Level IV (Diagnostic)

We describe a 13-year-old boy with piso-hamate coalition confirmed by X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed type 1 coalition according to the classification of DeVilliers Minnaar. Piso-hamate coalition is rare, and suspicions should be raised in instances of chronic ulnar-sided wrist pain, particularly in individuals with a history of elevated hand usage, especially amongst athletes engaging in intensive hand grip activities. Surgical resection of the synchondrosis site between the pisiform and the hamate is an efficacious intervention that can mitigate pain.

Level of Evidence: Level V (Therapeutic)