UC Davis

Introduction

A rare case of traumatic, isolated dislocation of the hamate with hook fracture in the setting of concomitant acute hand compartment syndrome is presented. This is the first described case of isolated hamate dislocation presenting with symptoms and examination consistent with acute compartment syndrome of the hand.

Case report

A 28-year-old man presented with a left hand crush injury. Plain radiographs demonstrated an isolated dorsal hamate dislocation without axial carpal dislocation and volar displacement of the hook fracture segment. Due to the clinical diagnosis of compartment syndrome, the patient was taken urgently to the operating room. Closed reduction of the hamate was performed, fasciotomies were performed, and the hamate was stabilized with percutaneous pinning. The patient at 6 months had full clinical recovery and returned to work.

Conclusion

Isolated, traumatic dislocation of the hamate is a rare injury that is most commonly caused by direct impact to the wrist at the level of the carpus. This injury can be readily diagnosed by history, physical examination, and radiographs. Computerized tomography scan may aid in diagnosis, but delay in treatment should not be tolerated in emergent cases. Importantly, crush injuries with a resulting hamate dislocation should increase clinical suspicion for hand compartment syndrome. If diagnosed and treated expediently, patients may benefit from improved and excellent outcomes.