Cecava Nathan D, Finn Mary F, Mansfield Liem T
Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA.
Royal Air Force Lakenheath Hospital, Suffolk, UK.
Emerg Radiol. 2017 Dec;24(6):689-695. doi: 10.1007/s10140-017-1523-5. Epub 2017 Jun 14.
Hamate fractures are estimated to represent 1.7% of all carpal fractures and can occur at the hamulus (hook) or hamate body depending on mechanism of injury. Fractures of the hamate body can be exceedingly difficult to identify on standard wrist and hand radiographs in the emergency department. If the diagnosis is missed in the emergency department, orthopedic referral is often delayed. This can result in lasting functional disability for the patient, as these fractures have a propensity to destabilize the fourth and fifth carpometacarpal (CMC) joints. In this pictorial essay, we present six radiographic signs indicative of hamate body fracture with computed tomography (CT) imaging correlation. Injury mechanism and fracture classification schemes are portrayed to aid in the understanding of these injuries. Once radiographs raise suspicion for a hamate body fracture, further characterization with CT and orthopedic referral is paramount. Goals of orthopedic management include reestablishment of the fourth and fifth CMC articular surface, stabilization of the CMC joints, and appropriate treatment of concomitant soft tissue injury.
据估计，钩骨骨折占所有腕骨骨折的1.7%，根据损伤机制的不同，可发生在钩突（钩）或钩骨体部。在急诊科，标准的手腕和手部X线片上很难识别钩骨体部骨折。如果在急诊科漏诊，骨科会诊往往会延迟。这可能会给患者带来持久的功能障碍，因为这些骨折易于使第四和第五掌腕（CMC）关节不稳定。在这篇影像学文章中，我们展示了六种提示钩骨体部骨折的X线征象，并与计算机断层扫描（CT）成像结果进行了对比。文中描述了损伤机制和骨折分类方案，以帮助理解这些损伤。一旦X线片引起对钩骨体部骨折的怀疑，通过CT进一步明确诊断并转诊至骨科至关重要。骨科治疗的目标包括恢复第四和第五掌腕关节的关节面、稳定掌腕关节以及妥善处理合并的软组织损伤。
