Avascular Necrosis of the Hamate Treated with a 4–5 Extensor Compartmental Artery Graft: A Case Report and Literature Review

Introduction: Avascular necrosis (AVN) of the hamate is an exceptionally rare condition, with limited cases reported in the literature. This case highlights the successful management of idiopathic hamate AVN using core decompression and a vascularized pedicle bone flap from the distal radius based on the 4–5 extensor compartmental artery (ECA). Case Report: A 45-year-old construction worker presented with chronic left wrist pain of 2 years’ duration following minor trauma. Despite conservative treatment with cast immobilization, the symptoms persisted. Magnetic resonance imaging revealed AVN of the hamate, prompting surgical intervention involving core decompression and a 4–5 ECA vascularized bone flap supplemented with cancellous autograft. Post-operative follow-up demonstrated significant functional improvement, grip strength restoration, and successful revascularization confirmed by imaging. Conclusion: This report demonstrates the successful use of the 4–5 ECA-based vascularized bone flap technique in managing hamate AVN, as well as a literature review of 13 previously described cases.