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Hamate Fractures and Ring/Little Finger CMC Fracture-Dislocations

51 citationsUpdated Sep 2026
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Overview

Hamate fractures and ring or little finger carpometacarpal (CMC) fracture-dislocations are uncommon but potentially disabling injuries that require a high index of suspicion to prevent suboptimal outcomes from delayed diagnosis [1, 3]. These injuries are likely more common than previously reported, particularly in young adults presenting to emergency departments [2, 15]. The mechanism typically involves a direct blow to a closed fist or high-energy trauma resulting in a longitudinally directed force along the fifth metacarpal axis [26]. This force causes proximal and dorsal subluxation of the metacarpal, accentuated by the pull of the extensor carpi ulnaris, abductor digiti minimi, and the oblique slope of the hamate [26]. While current literature consists largely of low-level case series [11], successful management hinges on early recognition and treatment of associated ulnar CMC joint instability [6, 8].

Diagnosis is frequently missed on routine radiographs, necessitating specific imaging protocols such as an AP view with the forearm pronated 30 degrees, a Brewerton view, or CT scans [26]. Three-dimensional CT reformatted views offer higher reliability than standard two-dimensional CT [26], while an oblique x-ray view is useful when clinical suspicion remains high despite normal initial films [17]. For suspected fifth CMC subluxation, radiographs in 60° of pronation from the lateral position are recommended [24]. Intra-articular fractures are uncommon and generally require open reduction and internal fixation with K-wires to reconstruct the articular surface [7]. Dorsal drilling for coronal hamate fractures is considered safe, as volar drill tips remain distant from ulnar nerve branches [10].

Treatment options range from closed reduction and cast immobilization to spanning external fixation or open reduction and internal fixation (ORIF) [26]. There is no consensus on optimal treatment, though ORIF is recommended for delayed presentations [22] and for unstable fracture-dislocations associated with comminuted dorsal or coronal hamate fractures [26]. Operative management, including headless compression screws or K-wire stabilization, yields good-to-excellent functional outcomes despite relatively high surgical complication rates [5, 14]. Patients generally sustain minimal functional deficits whether managed operatively or nonsurgically [13], although delayed ulnar-nerve palsy due to extraneural fibrosis is a recognized risk requiring close follow-up [16]. Postoperative wrist recovery is rapid, though finger extension may remain poor for over three months [18].

Anatomy & Pathophysiology

Bony Anatomy and Articulation

The hamate articulates with the ring and small metacarpals via two concave facets separated by a ridge [26]. The ring finger and small metacarpal bases share a common articulation with the hamate [31]. There is 15 to 30 degrees of mobility between the ring and small finger metacarpal bases and the hamate at the CMC joint [31]. The alignment of interosseous ligaments between the fourth and fifth metacarpals differs from those between the second-third and third-fourth metacarpals, allowing approximately 25° of flexion/extension in the fifth CMC joint compared to approximately 15° in the fourth CMC joint [50].

Hamate fractures, including hook fractures and those of the hamate body, account for 2–4% of all carpal fractures [25]. Hamate-metacarpal fracture-dislocations constitute 10–15% of carpometacarpal region fracture-dislocations [25]. Intra-articular fractures of the hamate are uncommon injuries [7]. Hamate body fractures predominantly occur in the dominant arm of young adult males [30]. A review of 120 cases in the literature showed that 96% of patients with hamate body fractures were male, with an average age of 29 years, and 93% had injuries involving their dominant hand [30].

Ligamentous Anatomy

Two distinct dorsal ligaments attach to the dorsal aspect of the fifth metacarpal: one extending from the ulnar base of the fifth metacarpal to the hamate, and another from the radial base of the fifth metacarpal to the hamate and sometimes to the fourth metacarpal ulnar base [50]. An intermetacarpal ligament attaches the radial base of the fifth metacarpal to the ulnar base of the fourth metacarpal [50]. One volar ligament attaches to the fifth metacarpal base and extends either to the hook of the hamate or to the ulnar base of the fourth metacarpal [50].

When metacarpals flex at the CMC joints, the dorsal interosseous ligament tightens and the anterior interosseous ligament relaxes [50]. When metacarpals extend at the CMC joints, the anterior ligament tightens and the posterior ligament relaxes, retaining a rigid interconnection between the bones [50].

Pathomechanics and Injury Patterns

Articular fractures of the hamate-metacarpal joint are typically the result of either a direct blow with a closed fist or high-energy trauma [26]. The most common mechanisms for hamate body fractures are striking a solid object with a clenched fist (52%) and falls (22%) [30]. Displacement of the fifth metacarpal is accentuated by the pull of the extensor carpi ulnaris [26]. The pull of the abductor digiti minimi and the oblique slope of the hamate contribute to the instability of CMC fracture-dislocations of the small finger [26].

Carpometacarpal dislocations of the hand with a simultaneous fracture of the hamate occur in less than 1% of osseous hand injuries [37]. The most common mechanism for carpometacarpal dislocations with a simultaneous hamate fracture is hyperflexion of the metacarpal heads [37]. Fracture-dislocations of the fourth and fifth metacarpal joints associated with comminuted dorsal hamate fractures or coronal fractures through the hamate are particularly unstable [26]. Isolated palmar ulnar dislocation of the fifth CMC joint is a rare injury with subtle radiographic findings that may be easily overlooked [28]. Carpometacarpal dislocations are uncommon and prone to wrist instability if not treated promptly [40].

Injuries to the body of the hamate, especially involving the little finger metacarpal articulation, are likely more common than reported [2]. A carpometacarpal dislocation with medial displacement of the fifth metacarpal and volar displacement of the fourth can produce compression of the deep branch of the ulnar nerve, resulting in an ulnar-nerve motor deficit [42].

Classification

Epidemiology and Mechanism

Hamate fractures constitute 2–4% of all carpal fractures [25].

Classification Systems

Milch et al.: The first classification of hamate fractures was established by Milch et al. in 1934 and does not include coronal fractures [25].

Cain: Cain’s classification focuses on the dislocation of the fifth carpometacarpal joint and further co-fractures of the hamate [25].

Ebraheim: Ebraheim’s classification focuses on the course of the fracture line through the hamate body, including coronal body fractures [25].

Kim and Shin: A novel hamatometacarpal fracture-dislocation classification system based on CT scan was proposed by Kim and Shin in 2012 [38].

3D CT-based: A classification system based on 3D CT images for ring and little finger carpometacarpal joint fracture subluxations has been evaluated for reliability [36].

Radiographic Assessment and Screening

Radiographs of the hand in 60° of pronation from the lateral are recommended if there is suspicion for a fifth carpometacarpal subluxation or dislocation [24]. The relative metacarpal shortening (RMS) is a radiographic measurement with almost perfect agreement between reviewers and is increased in fourth and fifth carpometacarpal fracture dislocations [33]. Both the 2-5 intermetacarpal angle (IMA) and the 3-5 IMA are useful screening measurements on lateral hand radiographs for detection of ulnar-sided carpometacarpal fracture-dislocations [34]. When evaluating posttraumatic ulnar-sided hand pain, advanced imaging should be considered if the index-small finger IMA or the little-small finger IMA is greater than 10° [55]. Isolated palmar ulnar dislocation of the fifth carpometacarpal joint is a rare injury with subtle radiographic findings that may be easily overlooked [28].

Other Considerations

The most optimal approach to treating carpometacarpal fracture-dislocations associated with hamate fractures remains a matter of debate, and treatment should be individualized for each patient, taking into account the limitations of existing classification systems [30].

Clinical Presentation

Mechanism of Injury

Hamate body fractures most commonly result from striking a solid object with a clenched fist (52%) or falls (22%) [30]. Carpometacarpal dislocations accompanied by a simultaneous hamate fracture typically occur via hyperflexion of the metacarpal heads, a mechanism that usually requires great force [37].

Clinical Findings and Diagnosis

Diagnosis of carpometacarpal dislocations with a simultaneous hamate fracture is frequently missed or delayed due to the high likelihood of other severe concomitant injuries [37]. Applying a high index of suspicion and performing a thorough clinical examination are prominent factors in recognizing these injuries [37]. Delayed diagnosis renders closed reduction difficult and is associated with less favorable radiographic outcomes [44].

Imaging protocols for hamate-metacarpal joint fractures include an anteroposterior (AP) view with the forearm pronated 30 degrees from the fully supinated position, as recommended by Bora and Didizian [26]. Diagnosis can also be established via CT or a Brewerton view [26]. Kim et al. reported that three-dimensional CT reformatted views demonstrate higher interobserver and intraobserver reliability than standard two-dimensional CT [26]. For ulnar-sided carpometacarpal fracture-dislocations, both the 2-5 IMA and the 3-5 IMA serve as useful screening measurements on lateral hand radiographs [34]. The Indian salutation test can raise the clinical index of suspicion for the ulnar type of fifth CMCJ dislocation [45].

Neurological Complications

Delayed ulnar-nerve palsy may occur following a hamate fracture due to extraneural fibrosis [16]. It is important to assess ulnar-nerve function at the time of injury and to follow patients closely for the possible development of delayed symptoms [16]. A case report describes a left carpometacarpal dislocation with medial displacement of the fifth metacarpal and volar displacement of the fourth, which produced an ulnar-nerve motor deficit [42].

Associated Injuries

Careful evaluation of intraoperative and postoperative imaging, particularly CT, is essential to detect rare persistent palmar trapezoid dislocations that may be missed on standard radiographs following surgical treatment of second through fifth carpometacarpal fracture dislocations [41].

Investigations

Radiographic Assessment

Plain radiography: A true lateral radiograph is required for the accurate diagnosis of carpometacarpal fracture-dislocations because swelling can obscure the deformity [80]. On a posteroanterior radiograph, loss of parallel joint surfaces at the carpometacarpal articulations is indicative of carpometacarpal fracture-dislocation [80]. For suspected fifth carpometacarpal subluxation or dislocation, radiographs of the hand obtained in 60° of pronation from the lateral are recommended [24]. Isolated palmar ulnar dislocation of the fifth carpometacarpal joint presents with subtle radiographic findings that may be easily overlooked [28]. When clinical suspicion for a hamate fracture remains high despite otherwise normal x-rays, an oblique x-ray view is of particular use [17].

CT: CT scans are beneficial for determining the extent of joint surface involvement in carpometacarpal fracture-dislocations [80]. CT imaging is important for detecting rare persistent palmar trapezoid dislocations that may be missed on standard radiographs following surgical treatment of second through fifth carpometacarpal fracture dislocations [41].

Other Considerations: The 2-5 intermetacarpal angle (IMA) and the 3-5 IMA are useful screening measurements on lateral hand radiographs for the detection of ulnar-sided carpometacarpal fracture-dislocations [34]. Measurement of the angle between the long axis of the second and fifth metacarpal bones on a true lateral radiograph is advocated for cases of fifth carpometacarpal dislocation, as the carpometacarpal angle is increased compared with controls (38.5° compared with 9.8°) [43].

Clinical Examination

The Indian salutation test can raise the clinical index of suspicion for ulnar type of fifth carpometacarpal joint dislocation [45]. Ulnar-nerve function must be assessed at the time of injury and patients followed closely for possible development of delayed symptoms following a fracture of the hamate [16]. A carpometacarpal dislocation with medial displacement of the fifth metacarpal and volar displacement of the fourth can produce an ulnar-nerve motor deficit [42].

Treatment

Diagnostic Considerations and Urgency

Accurate diagnosis of fifth carpometacarpal (CMC) fracture-dislocations requires specific imaging protocols. Bora and Didizian recommend an anteroposterior view with the forearm pronated 30 degrees from the fully supinated position [26]. For three-dimensional assessment, CT reformatted views demonstrate higher interobserver and intraobserver reliability than standard two-dimensional CT [26].

Non-Operative

Conservative management is a viable option when the diagnosis of an ulnar CMC joint dislocation or fracture–dislocation is made early and a concentric, stable reduction is initially achieved, provided close follow-up is maintained for the first week [9]. Undisplaced fractures may be treated conservatively with good results [20]. Although operative treatment is often recommended, conservative management through immediate reduction and splint immobilization can be sufficient for acute, uncomplicated ulnar CMC dislocations [86]. In the series by Petrie and Lamb, despite persistent metacarpal shortening, articular surface incongruity, and joint widening, only one patient experienced pain significant enough to affect work [26].

Operative

Indications: Displaced fractures or those with associated metacarpal subluxation are better treated with open reduction and internal fixation to minimize residual deformity and dysfunction [20]. Treatment for carpometacarpal fracture-dislocations associated with hamate fractures should be individualized for each patient, taking into account the limitations of existing classification systems [30].

Surgical Approach / Technique: Favorable outcomes have been shown after open reduction and internal fixation of the hamate body fracture with interfragmentary screws, combined with stabilization of the CMC dislocation using percutaneous Kirschner wires [4]. Percutaneous pinning is considered the gold standard and safest procedure for CMC dislocation second to fifth with associated hamate fracture, though open reduction is advantageous in certain circumstances [62]. In a case series of 11 patients treated with open reduction and buttress plate application, 5 patients (45%) required a second surgery for hardware removal [26]. The use of a suture button implant allows early motion from 2 weeks after surgery, resulting in good motion of the ulnar CMC joints and increased hand grip [35]. Closed reduction was successful in only one of four patients with multiple carpometacarpal dislocations; open reduction and fixation was necessary in the others [59]. A procedure for open dislocation of the scaphoid with an associated hamate fracture and fourth metacarpal fracture resulted in optimal reduction and fixation with no persistent dorsal intercalated segment instability deformity or carpal malalignment [58].

Ring Finger Ray Amputation and Transposition: Le Viet described a technique involving complete ring finger ray resection, an intracarpal wedge-shaped osteotomy, and a capitohamate arthrodesis for small finger translocation [21]. This technique offers four main advantages: avoidance of convergence between the small finger and long finger, maintenance of the integrity of the ulnar side of the hand, preservation of the fifth CMC joint, and unchanged action of the interossei [21]. In a series of 17 patients treated with Le Viet's transposition technique, 14 were satisfied with preservation of motion at the CMC joint [21]. Posner described a step-cut osteotomy that adds height to the small finger during transposition to the ring finger metacarpal base to mitigate length discrepancy, capable of lengthening the small finger by 1.5 cm [21].

Biomechanics and Soft Tissue Management: In the ring finger, there is 15 to 30 degrees of mobility between the ring and small finger metacarpal bases and the hamate at the CMC joint [31]. It is possible for the base of the fifth metacarpal to slide radially if the entire fourth metacarpal is excised due to the lack of tendinous attachments to the fourth metacarpal base [31]. Transmetacarpal ray resection of the ring finger can leave an open space between the long finger and small finger as the remaining metacarpal base cannot converge [31]. Complete deletion of the ring finger can lead to a loss of small finger abduction and possible scissoring [31]. Steichen and Idler reported that it was easier to close the intermetacarpal space between the long finger and small finger compared with the space between the index finger and ring finger after ray amputation [31]. In their series, cosmetic and functional results were satisfactory in 12 of 13 patients who underwent central ray resection without transposition [31]. Morgan and colleagues noted that a suture button was able to provide a more stable gap than repair of the transverse intermetacarpal ligaments after ring finger ray amputation, permitting earlier range of motion [31]. For ring finger ray amputation without transposition, the DTIL is imbricated in a pants-over-vest configuration with 3-0 nonabsorbable sutures [31]. Temporary transverse Kirschner wires can be placed between the long finger and small finger metacarpals after ring finger ray amputation without transposition and are removed after 4 to 6 weeks [31].

Complications

Nerve Injury

The provided evidence does not document specific nerve injury rates or management protocols for this pathology.

Functional Deficits and Outcomes

Diagnostic Delay: Delay in diagnosis and treatment of lesser digit carpometacarpal joint fracture-dislocations leads to suboptimal outcomes [1]. Recovery Trajectory: Following an unusual carpometacarpal fracture-dislocation, postoperative wrist recovery was rapid, although finger extension remained poor for over 3 months [18]. Long-Term Stability: Five years and two months after open reduction and internal fixation of an unusual multiple carpometacarpal dislocation, radiographs demonstrated anatomical positioning of the metacarpals with no observed degenerative arthritis of the carpometacarpal joints [32].

Hardware and Surgical Risks

Hardware Removal: Following open reduction and buttress plate application for fifth metacarpal-hamate fracture-dislocations, five patients (45%) required a second surgery for hardware removal [26]. Technical Learning Curve: The technique of ring finger ray amputation with transposition of the fifth metacarpal carries a recognized learning curve [21].

Degenerative Changes

Arthritis Correlation: In cases of fifth metacarpal-hamate fracture-dislocations, pain directly correlated with degenerative arthritis, which was attributed to nonanatomic reduction [26].

Recovery

Other Considerations: Delayed diagnosis of lesser digit carpometacarpal joint fracture-dislocations can lead to a suboptimal outcome [1]. Carpometacarpal joint dislocations and fracture dislocations can be very disabling if not recognized early [3]. Operative management of CMC fracture dislocations results in good-to-excellent functional outcomes despite relatively high surgical complication rates [5].

Functional milestones: Five years and two months postoperatively, radiographs showed anatomical positioning of the metacarpals and degenerative arthritis of the carpometacarpal joints was not observed [32]. The functional result after 2 years seems acceptable compared to the results described in the literature, with 70% of range of motion, 75% of strength, and only mild remaining symptoms [56]. This approach was associated with an excellent short-term functional outcome [57].

Key Evidence

  • [L5] Treating physicians need to maintain a high index of suspicion regarding lesser digit carpometacarpal joint fracture-dislocations as delay in diagnosis and treatment can lead to a suboptimal outcome. [1] (10.1016/j.jhsa.2026.02.016)
  • [L5] Injuries to the body of the hamate, especially involving the little finger metacarpal articulation, are likely more common than reported and should be recognized. [2] (10.1016/j.jhsa.2014.08.026)
  • [L5] Carpometacarpal joint dislocations and fracture dislocations are uncommon injuries that can be very disabling if not recognized early. [3] (10.5435/jaaos-d-25-00583)
  • [Paper] The study showed favorable outcomes after open reduction and internal fixation of the hamate body fracture with interfragmentary screws, when combined with stabilization of the CMC dislocation with percutaneous Kirschner wires. [4] (10.1055/s-0039-1692326)
  • [L4] Despite relatively high surgical complication rates, operative management of CMC fracture dislocations results in good-to-excellent functional outcomes. [5] (10.1016/j.jhsg.2024.11.003)
  • [L5] Successful treatment of coronal hamate fractures requires identification and treatment of associated disruption or instability of the ulnar 2 carpometacarpal joints. [6] (10.1016/j.hcl.2012.05.010)
  • [L5] Intra-articular fractures of the hamate are uncommon injuries and we would recommend open reduction and internal fixation with K-wires in an attempt to reconstruct the articular surface. [7] (10.1016/0020-1383(93)90187-b)
  • [Paper] It is important to diagnose and treat the Carpometacarpal joint dislocation to avoid considerable morbidity associated with it. [8] (10.1007/s12593-010-0018-3)
  • [L4] If the diagnosis of an ulnar CMC joint dislocation or fracture–dislocation is early accomplished and a concentric and stable reduction is initially achieved, the nonoperative treatment may be a successful option to take into account but requiring a close follow-up for the first week. [9] (10.1055/s-0039-1688468)
  • [L5] Dorsal drilling of coronal hamate fractures appears to be safe, as volar drill tips are well away from ulnar nerve motor and sensory branches. [10] (10.1016/j.jhsa.2022.04.023)
  • [L3] The current literature on ulnar-sided carpometacarpal fractures and fracture-dislocations consists of case series with a low level of evidence. [11] (10.1016/j.otsr.2020.03.039)
  • [Case_report] In cases of five CMC joint dislocations associated with a hamate body fracture, the authors recommend addressing the hamate fracture with open reduction and internal fixation prior to proceeding with reduction and pinning of the CMC joints. [12] (10.1177/1558944716668860)
  • [L4] Patients who sustain hamate fractures have minimal functional deficits whether managed operatively or nonsurgically. [13] (10.1016/j.jhsg.2024.02.002)
  • [L4] Operative treatment with headless compression screws is a safe procedure with good clinical outcomes for acute dislocated hamate corpus fractures and nondisplaced fractures of the hook of the hamate bone. [14] (10.1055/s-0039-1695765)
  • [L4] Fracture of the body of the hamate is a more common injury presenting to accident and emergency departments than previously described, especially in young adults. [15] (10.1016/0020-1383(91)90129-3)
  • [L4] Delayed ulnar-nerve palsy can occur following a fracture of the hamate due to extraneural fibrosis, and it is important to assess ulnar-nerve function at the time of injury and follow patients closely for possible development of delayed symptoms. [16] (10.2106/00004623-196850030-00017)
  • [Case_report] An oblique x-ray view is of particular use when clinical suspicion for hamate fracture remains high in the light of otherwise normal x-rays. [17] (10.1186/1749-799x-5-64)
  • [L5] Postoperatively recovery of the wrist was rapid, though extension of the fingers remained poor for over 3 months. [18] (10.1016/0020-1383(94)90161-9)
  • [Case_report] Dorsal buttress plating between the hamate and the capitate could be an alternative technique for the treatment of fracture-dislocation of the fifth CMC joint with avulsion fracture of the hamate. [19] (10.1007/s00402-018-3072-0)
  • [L4] Undisplaced fractures may be treated conservatively with good results, while displaced fractures or those with associated metacarpal subluxation are better treated with open reduction and internal fixation to minimize residual deformity and dysfunction. [20] (10.1177/1753193408098907)
  • [L4] In patients with delayed presentation of CMC fracture dislocations, we recommend ORIF. [22] (10.1016/j.jhsa.2015.07.017)
  • [L4] The authors recommend obtaining radiographs of the hand in 60° of pronation from the lateral if there is suspicion for a fifth CMC subluxation or dislocation. [24] (10.1016/j.jhsa.2018.04.012)
  • [Paper] [25] (10.3205/iprs000131)
  • [L4] Isolated palmar ulnar dislocation of the fifth CMC joint is a rare injury with subtle radiographic findings that may be easily overlooked. [28] (10.1007/s004029900111)
  • [L2] The clinically appropriate fixation method should be selected according to the experience of the surgeon and the degree and type of fracture and dislocation. [29] (10.1186/s13018-023-04225-2)
  • [Paper] [30] (10.52312/jdrs.2025.1997)
  • [L5] Five years and two months postoperatively, radiographs showed anatomical positioning of the metacarpals and degenerative arthritis of the carpometacarpal joints was not observed. [32] (10.1016/s0020-1383(97)82145-6)
  • [L4] The relative metacarpal shortening (RMS) is a radiographic measurement with almost perfect agreement between reviewers and is increased in fourth and fifth carpometacarpal fracture dislocations. [33] (10.1016/j.jhsa.2025.08.011)
  • [L4] Both the 2-5 IMA and the 3-5 IMA are useful screening measurements on lateral hand radiographs for detection of ulnar-sided carpometacarpal fracture-dislocations. [34] (10.1016/s0363-5023(11)60044-0)
  • [L4] The surgical treatment using a suture button implant allowed early motion from 2 weeks after surgery, which resulted in good motion of the ulnar CMC joints and increased hand grip. [35] (10.1055/s-0039-1693051)
  • [L4] [36] (10.1177/1753193415602589)
  • [L5] [37] (10.1155/2020/2861604)
  • [Paper] [38] (10.1007/s00402-026-06366-5)
  • [L4] Carpometacarpal dislocations are uncommon and prone to wrist instability if not treated promptly. [40] (10.1016/j.otsr.2016.04.003)
  • [L4] This report highlights the importance of careful evaluation of intraoperative and postoperative imaging, particularly CT, to detect rare persistent palmar trapezoid dislocations that may be missed on standard radiographs. [41] (10.1016/j.jhsg.2025.100769)
  • [L4] A case is reported of a left carpometacarpal dislocation with medial displacement of the fifth metacarpal and volar displacement of the fourth, producing an ulnar-nerve motor deficit. [42] (10.2106/00004623-197153070-00016)
  • [L4] Measurement of the angle between the long axis of the second and fifth metacarpal bones on a true lateral radiograph, in cases of fifth carpometacarpal dislocation is advocated, as the carpometacarpal angle is increased compared with controls (38.5° compared with 9.8°). [43] (10.1016/s0020-1383(05)80042-7)
  • [L4] Delayed diagnosis makes closed reduction difficult and was associated with less favorable radiographic outcome. [44] (10.1177/1558944719852743)
  • [Case_report] Ulnar type of fifth CMCJ dislocation is a very rare injury, and the Indian salutation test that raised the clinical index of suspicion and confirmed by radiograph followed by closed reduction and percutaneous K-wires fixation gives an excellent outcome. [45] (10.1055/s-0039-1680277)
  • [Paper] [50] (10.1016/j.hcl.2011.05.010)
  • [L3] When evaluating posttraumatic ulnar-sided hand pain, advanced imaging should be considered if the I-S IMA or the L-S IMA is greater than 10°. [55] (10.1016/j.jhsa.2012.05.042)
  • [L4] The functional result after 2 years seems acceptable compared to the results described in the literature, with 70% of range of motion, 75% of strength, and only mild remaining symptoms. [56] (10.1016/j.jhsa.2007.11.003)
  • [Case_report] This approach was associated with an excellent short-term functional outcome. [57] (10.1007/s12593-015-0191-5)
  • [L4] The procedure resulted in optimal reduction and fixation with no persistent dorsal intercalated segment instability deformity or carpal malalignment. [58] (10.1016/j.jhsg.2023.10.004)
  • [L4] Closed reduction was successful in only one of four patients; open reduction and fixation was necessary in the others. [59] (10.2106/00004623-197961060-00018)
  • [L5] [62] (10.1016/j.ijscr.2023.108417)
  • [L4] Although operative treatment is recommended in the literature, these cases show that conservative treatment through immediate reduction and splint immobilization can be sufficient for acute, uncomplicated ulnar CMC dislocations. [86] (10.1007/s11552-011-9347-3)

See Also

References

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[2] Are Hamate Fractures Common? Letter Regarding “Carpal Fractures” Article. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.08.026

[3] Carpometacarpal Joint Dislocations and Fracture Dislocations of the Index Through Small Digits. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00583

[4] Carpometacarpal 4/5 Fracture Dislocations: Fracture Morphology and Surgical Treatment. Journal of Hand and Microsurgery. 2020. DOI: 10.1055/s-0039-1692326

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[6] Fractures of the Hamate and Pisiform Bones. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.010

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[8] Dislocation of Second and Third Carpometacarpal Joints Along with Fracture of First Metacarpal–Possible Mechanisms. Journal of Hand and Microsurgery. 2010. DOI: 10.1007/s12593-010-0018-3

[9] Nonoperative Treatment of Ulnar Carpometacarpal Fracture–Dislocations. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1688468

[10] Dorsal Fixation of Coronal Hamate and Fifth Metacarpal Base Fractures: An Anatomic Evaluation of the Ulnar Nerve. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.04.023

[11] Ulnar-sided carpometacarpal fractures and fractures-dislocations. A systematic review and publication guidelines. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2020.03.039

[12] Coronal Hamate Fracture Associated With Carpometacarpal Dislocations of All of the Fingers: Review of the Literature and Case Report. HAND. 2016. DOI: 10.1177/1558944716668860

[13] Study of Hamate Fractures in a Single Tertiary Hands Unit: A Retrospective Cohort Study and Literature Review. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.02.002

[14] Functional Outcome following Headless Compression Screw Fixation for Hamate Fractures. Journal of Wrist Surgery. 2019. DOI: 10.1055/s-0039-1695765

[15] Fractures of the body of the hamate. Injury. 1991. DOI: 10.1016/0020-1383(91)90129-3

[16] Delayed Ulnar-Nerve Palsy Following a Fracture of the Hamate. The Journal of Bone & Joint Surgery. 1968. DOI: 10.2106/00004623-196850030-00017

[17] Lessons to be learned from a missed case of Hamate fracture: a case report. Journal of Orthopaedic Surgery and Research. 2010. DOI: 10.1186/1749-799x-5-64

[18] An unusual carpometacarpal fracture—dislocation. Injury. 1994. DOI: 10.1016/0020-1383(94)90161-9

[19] Dorsal buttress plate fixation for the treatment of fracture–dislocation of the fifth carpometacarpal joint with avulsion fracture of the hamate: a case report. Archives of Orthopaedic and Trauma Surgery. 2018. DOI: 10.1007/s00402-018-3072-0

[20] Outcome following coronal fractures of the hamate. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408098907

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[22] The Effect of Timing on the Treatment and Outcome of Combined Fourth and Fifth Carpometacarpal Fracture Dislocations. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.07.017

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