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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2011 December;62(6):479-83
Growth factors platelet derived gel infiltration as treatment for missed hamate hook like process non union fracture
Crescibene A. 1, Costabile E. 1, Napolitano M. 2, Almolla H. 3
1 Operative Unit of Orthopedy and Traumatology, Cosenza Hospital, Cosenza, Italy;
2 Operative Unit of Immunohematology and Transfusional Medicine, Cosenza Hospital, Cosenza, Italy;
3 Operative Unit of Radiology, Cosenza Hospital, Cosenza, Italy.
The hook like process fracture of the hamate bone is a relatively rare event and needs specific radiographic positioning to be properly diagnosed which is difficult to obtain in painful traumatic patients. We describe a case of a missed fracture of the left hamate in a young male who came to our attention with a non union hook fracture. The particular vascolarization of the hamate predisposes for such a complication as it is fed by two arteries, one is absent in 29% of subjects, such a condition is the main source of possible osteonecrosis and post-traumatic nonunion. Clinical condition of functional impairment, wrist pain and long lasting time from the moment of the traumatic event suggested a conservative approach to the treatment which was undertaken infiltrating, under fluoscopic guidance, the carpo-metacarpal joint space with autologous blood derived platelet rich gel. The procedures were repeated three times on a 15 day distance basis, at the end of treatment we noticed a definite improvement of both flexion, extension, adduction and abduction of the wrist. Computed tomography confirmed the callus formation and healing of the fracture, rapid functional recovery was also accompanied with lack of complications. The purpose of the case presentation is to withdraw attention to coaduvating missed non union fracture of the hook like process of the hamate bone utilizing autologous blood derived platelet gel to obtain enhancement of the healing process with growth factors.