A 42-Year-Old Female with Pain After a Child Fell on Her Hand

The Resolution

 

Differential Diagnosis

• Hamate fracture
• Scaphoid fracture
• Carpal lunate dislocation
• Pisiform fracture

 

Diagnosis

This patient has a hairline hamate fracture. These account for 2%–4% of all carpal bone fractures.

Learnings/What to Look for

• The hamate fracture is commonly missed due to the complexity of the anatomy of the carpal bone area and the presence of other distracting injuries
• Hamate fractures can be occult in 60% of cases by radiography alone, and may necessitate CT
• Hamate body fractures are commonly associated with fourth and fifth metacarpal base fractures

Pearls for Urgent Care Management and Considerations for Transfer

• Nondisplaced fractures can be treated on site with immobilization, with a recommendation for close follow-up with an orthopedist
• Displaced hook of the hamate fractures can be treated with fragment excision
• Displaced body fractures require open reduction and internal fixation

Acknowledgment: Images and case provided by Experity Teleradiology (www.experityhealth.com/teleradiology).