Question: Hello, I have had surgery to repair a fractured hamate bone. The piece of bone which fractured off was large enough to accommodate two 2.3mm screws so the surgery was a success in that there is a good fix. However, the 3rd and 4th knuckles are still clearly depressed and there is a lump on the back of my hand. My surgeon assures me that the 4th and 5th metacarpals are correctly positioned now but I still have this rather ugly lump. I am wondering what is causing the lump. It feels hard like bone. He also assures me that he is confident I will eventually have full pre-op, hand function and grip strength. This is of course the main priority, but what is causing the lump. He told me frankly he didn't know. Is it cartilage that has been compressed by the impact? Or some kind of callus ? Will it eventually reduce?

Dear Dr XXXXXXX
Thank you very much for your prompt reply. I appreciate that is is very difficult to be more precise without being able to see the the X-ray or examine the trauma yourself. I have seen the one taken immediately post-surgery, where you can see the screws, etc. I am back into the clinic next week to have the cast changed and I will ask for a copy to send you. In the meantime I will call them and ask if it can be sent sooner.
The pre-op X-ray showed that the 4th/5th MC had impacted the hamate, causing the fracture, but the 4th MC had remained in situ, sitting past the normal alignment. The surgeon said he had got it back to it's normal length, but the depressed knuckle suggests otherwise.
When you say the lump might be due to malunited 4th/5th MC, do you mean that the joint between the hamate and MC's is potentially not properly aligned ? Is it possible the lump is caused by the end of the 4th MC sitting proud of the top of the Hamate ? Would the unison between the 4th and hamate mend by itself and then the lump would reduce?

Or to re-phrase the question, in your opinion, would one normally expect to be left with a lump post-surgery ( allowing for tissue bruising - it is more significant than that ) unless there was still a problem ?
I have excellent use of my fingers and little pain, apart from to connect thumb with 5th finger tip which IS very painful, but the fact that the knuckles are still clearly depressed compared to my other hand ( or pre-trauma ) and that I have this lump is disturbing. Would it be normal to have these factors left ? ( My surgeon told me it was a particularly bad hamate fracture with serious compression of the 4th/5th MC's, but that the operation had exceeded his expectations ) He told me that the aesthetic loss to my hand was not significant given the success of the fix, and that it was to be expected. I am not a vain man, I can live with that although my hand is left slightly disfigured, but I'd like to be more confident that I should not expect a better result.

I very much appreciate that you can only give me a rather generic diagnosis without examination, but I am keen to understand whether I should accept I may be left with a lump or not ?

Best wishes and many thanks,
XXXXXX

Dear Dr XXXXXXX

Thank you very much for your reply. I have contacted the surgeon's secretary and requested a copy of the X-ray. If you choose to send me your personal email address I will email you a copy, simply for you to look at if you are interested, I am very satisfied that you have answered by original question.
My email address is YYYY@YYYY
Of course if you do not feel comfortable giving me your personal email address I will quite understand, but I thought you may be interested to see the picture.
They will do another X-ray in 2 weeks time apparently.
Thank you very much for your time and expertise in comprehensively responding to my enquiry and I wish you the very best for the future.

I am confident that I will have excellent use of my hand again and that is the priority. I am a little disappointed I am left with a slight disfigurement, but it will not have any meaningful effect upon my quality of life.

Kind regards,
XXXXXX