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Radiographic signs of hook of hamate fracture: evaluation of diagnostic utility

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Abstract

Objective

Hook of hamate fracture, the most common swing-related wrist fracture, is commonly seen in high-level athletes. The fracture is rarely diagnosed on routine wrist radiographs, thus generally requiring CT or MR for diagnosis. Surgical excision has a high success rate, however diagnostic delay contributes to a high complication rate. Radiographic signs of hook of hamate fracture have been published, but uncertainty of the diagnostic accuracy limits application. The purpose of this study is to determine accuracy and interobserver reliability of radiographic signs of hook of hamate.

Materials and methods

This retrospective case-control study evaluated wrist radiographs of 50 patients, including 24 positive and 26 negative, for hook of hamate fracture, each proven by CT or MR. Five reviewers performed blinded, randomized evaluation of radiographs documenting whether the hook of hamate was normal or fractured, and if fractured, the radiographic signs present (ring sign, ghostly shadow, and diffuse sclerosis) and views that contributed to diagnosis.

Results

Radiographic signs demonstrated high sensitivity (85%; 95% CI: 77–91), specificity (92%; 95% CI: 86–96), and accuracy (89%; 95% CI: 84–92) with substantial interobserver reliability (k = 0.652). The ring sign was the most sensitive radiographic sign. Diagnosis was most often supported by the oblique view (38%) and rarely the lateral view (15%).

Conclusions

Radiographic signs of hook of hamate fracture on routine radiographs can accurately and reliably diagnose hook of hamate fractures. Evaluation for discontinuity of the cortical ring will optimize sensitivity, allowing for timely diagnosis and treatment, and a reduction of complications.

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Acknowledgements

Thanks to Brian Everist, MD, Douglas Nelson, MD, Gary Hinson, MD, Kevin Brown, MD, and Anders Grinde, MD for contributing their time and expertise to imaging interpretations. Thanks to Lauren Clark, MS and Shelby Bell for their contributions to statistical analysis.

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Authors and Affiliations

  1. Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, 66160, USA

    Jayden Spencer, Carissa Walter & Brian Everist

  2. Department of Biostatistics, Kansas University Hospital, 3901 Rainbow Blvd, MS 1026, Kansas City, KS, 66160, USA

    Suzanne L. Hunt & Chuanwu Zhang

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  1. Jayden Spencer
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  2. Suzanne L. Hunt
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  4. Carissa Walter
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Correspondence to Jayden Spencer.

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Spencer, J., Hunt, S.L., Zhang, C. et al. Radiographic signs of hook of hamate fracture: evaluation of diagnostic utility. Skeletal Radiol 48, 1891–1898 (2019). https://doi.org/10.1007/s00256-019-03221-0

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  • DOI: https://doi.org/10.1007/s00256-019-03221-0

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