| 제목 |
Isolated Hamate Fracture and Combined Ulnar Nerve Injury |
| 소속 |
Dongguk University Ilsan Hospital, Department of Rehabilitation Medicine 1 |
| 저자 |
Hee Jae Kim1*, Ki Yeun Nam1†, Bum Sun Kwon1, Jin Woo Park1, Ho Jun Lee1, Kyu Jeong Sim1, Dong Chan Yang1, Kyung Hwan Lee1, Hyo Jun Kim1, Da Yoon Park1, Seung Yeun Kim1, Tae Jun Park1, Yong Jin Jo1 |
Fractures of the hamate are considered to be relatively rare, only 2% of total carpal bone fractures. We report the case of fracture of hamate fracture combined with ulnar nerve injury with electrodiagnostic study.
A 41-year-old, man presented with a 3 month history of pain on the ulnar side of his left hand after hitting the ground heavily behind the ball with his golf club. Wrist & hand x-ray finding was normal. The initial diagonosis of local medical center was the triangular fibrocartilage complex injury, he took NSAIDs and immobilization treatment. But, the pain was not relieved, he visited our hospital after 3 month of first symptom. We found atrophy in hypothenar, interosseous muscle in his left hand, his grasp and pinch grip strengthening was weakened, but sensation was normal. The ulnar side wrist pain was exacerbated by ulnar deviation of the affected hand. We suspected ulnar nerve injury and TFCC injury and performed electrodiagnostic evaluation for confirming ulnar neuropathy. In ulnar nerve motor conduction study, it showed decreased amplitude in left FDI muscle. In needle EMG, we also found left FDI muscle reduced motor unit recruitment. We could diagnose ulnar neuropathy, Guyon’s canal syndrome, type II and checked bone scan and wrist MRI for finding out concealed fracture and space occupying lesion. As a result, it revealed increased uptake on left ulnar aspect of the distal carpus on bone scan, wrist MRI showed bone marrow edema in left hamate, no evidence of TFCC injury. The hook of hamate fracture which was confirmed by CT. The patient was treated operative reduction and his grip power gradually increased.
Hamate fractures continue to pose a diagnostic and therapeutic challenges for the physician. The relative rareness of the injury pattern, and complex carpal anatomy can make this diagnosis commonly missed. For this reason, carefully hearing the patient’s history is important and a high index of suspicion is mandatory for accurate and prompt diagnosis in hamate fracture. |
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