Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand
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A rare case of isolated traumatic hamate dislocation combined with fracture of the hamate hook is reported. Plain X-rays revealed a volar dislocation of the hamate, but computed tomography was necessary to recognise the fracture of the hamate hook. The injury was successfully treated with open reduction and internal fixation with Kirschner wires. ⋯ Cone-beam computed tomography, a novel imaging modality in hand surgery, was successfully used during follow-up. We conclude that computed tomography is essential in emergency preoperative planning in this type of uncommon injuries in order to diagnose concomitant bony lesions which can otherwise be overlooked. Alternative treatment options are discussed, and literature is reviewed.
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Comparative Study
Arthroscopic direct repair for radial tear of the triangular fibrocartilage complex.
Although various repair techniques for Palmer type 1B lesions of the triangular fibrocartilage complex (TFCC) have been introduced, arthroscopic repair techniques for Palmer type 1D lesions are still being honed. Until recently, inside-out techniques have commonly been used to repair radial tears of the TFCC. However, that technique has the disadvantages of a requirement for an extra skin incision, pain resulting from prominent subcutaneous suture knot stacks, and peripheral nerve injury. We describe an all-arthroscopic direct-repair technique using a suture hook with 2-0 polydioxanone that is relatively simple and safe and is thus a useful alternative for radial tears of the TFCC.
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Open fixation of acute fractures, delayed union and non-union of the hamate hook through a palmar approach has been reported. Minimal invasive fixation using a dorsal percutaneous approach and a headless cannulated mini-screw is another option not commonly considered. The authors present their case series of patients who underwent dorsal percutaneous fixation of acute fractures and delayed union of the hamate hook. ⋯ This pilot study demonstrates that non-displaced acute fractures and delayed union of the hamate hook can be treated successfully by dorsal percutaneous cannulated mini-screw fixation with minimal morbidity and complications.
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Modified single-incision distal biceps tendon repair using three suture anchors: surgical technique.
Complete distal biceps tendon rupture causes a considerable loss of supination and flexion strength, and thus, surgical repair is indicated in active individuals. To reduce the risk of injury to the radial nerve in the confined space where the distal biceps inserts into the radius, several surgical methods have been reported, such as, pull out sutures, two-incision techniques, and the use of suture anchors. Here, we describe our modified single-incision distal biceps tendon repair technique using three suture anchors, which widens the bone-tendon contact surface and simplifies tensioning of the tendon attachment.
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Case Reports
Clinical outcomes of hook of hamate fractures and usefulness of the hook of hamate pull test.
We report the usefulness of hook of hamate pull test (HHPT), described by Wright et al. in 2010, along with therapeutic outcomes of hook of hamate fractures. Eleven patients (two with fresh fractures and nine with nonunion) were studied. The fractures were diagnosed with HHPT for recently encountered 4 patients and a definitive diagnosis was made by a carpal canal view and a computed tomography (CT) scan. ⋯ Patients returned to work/sports two months postoperatively. HHPT was useful for diagnosing both fresh fractures and nonunion. If HHPT is positive, CT should be performed even if the fracture is obscure on a carpal canal view.