Hamate body and capitate fracture in punch injury.

Hamate fractures represent only 2% to 4% of all carpal bone fractures because they require a large degree of force to the hand or wrist. This is a case report of a patient with hamate and capitate fractures after a punch injury. It details the minute change seen in routine 3-view radiographic imagery and indications for computed tomography. A 29-year-old African American man with professional boxing training presented to the emergency department with pain and swelling in the hand and wrist after striking a refrigerator with his right hand. Enough force generated along the axial plane of the fourth and fifth metacarpals either from punching or from falling with a clenched fist is capable of fracturing both the hamate and capitate bones. Three-view radiographs may not visualize the fracture, so computed tomography should be ordered to better visualize any pathology. The risks to not detecting a hamate body fracture are nonunion of the bone, posttraumatic arthritis, decreased grip strength, and decreased range of motion of the hand. Because of rarity, there is no criterion standard therapy, but the general approach is open reduction and internal fixation using Kirschner wires and wrist immobilization for a minimum of 8 weeks. A high degree of clinical suspicion on examination is required for the proper approach to confirm a hamate fracture.