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Hamate Fracture
From WikiSM
Other Names
- Hook of Hamate fracture
- Hamate avulsion fracture
Background
- Hamate fractures represent about 2% of all carpal fractures
Pathophysiology
- Mechanism
- Direct compression of hook of hamate
- Avulsion fracture of pisohamate ligament
Risk Factors
- Sports
- Racket sports
- Baseball
- Golf
- Hockey
Differential Diagnosis
Carpal Bone Fractures
- Scaphoid Fracture
- Lunate Fracture
- Triquetrum Fracture
- Pisiform Fracture
- Trapezium Fracture
- Trapezoid Fracture
- Capitate Fracture
- Hamate Fracture
Differential Diagnosis Wrist Pain
- Fractures
- Dislocations
- Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
- Carpometacarpal Joint Dislocation
- Distal Radioulnar Joint Dislocation
- Lunate Dislocation
- Perilunate Dislocation
- Instability & Degenerative
- Tendinopathies & Ligaments
- Neuropathies
- Pediatric Considerations
- Distal Radial Epiphysitis (Gymnast's Wrist)
- Torus Fracture
- Arthropathies
- Cartilage
- Vascular
- Other
Clinical Features
- General: Physical Exam Wrist
- Patients may not endorse a clear mechanism or history of injury
- Vague pain at the base of the Hypothenar Muscles
- Pain is worse with gripping or direct palpation over hook of hamate
- Patients may report symptoms in Ulnar Nerve distribution
- Pain with Hook of hamate pull test
Evaluation
Radiographs
- Standard Radiographs Wrist
- 3 view initially
- May need carpal tunnel, supinated oblique view
- Consider 1st webspace view
CT scan
- Better at determining location, extend of fracture
Classification
- Hook
- Body
- Proximal pole
- Medial tuberosity
- Sagittal oblique
- Dorsal coronal
Management
Nonoperative
- Approximately 50% healing rate of waist and tip fractures due to poor vascularity[1]
- Hook of hamate indications
- Nondisplaced
- Body of hamate indications
- Nondisplaced
- Cast: Short Arm Cast 4-6 weeks
Operative
- Hook of hamate indications
- Failure of nonoperative approach
- Displaced
- Chronic
- Ulnar nerve compression
- Body of hamate indications
- Displaced
- Carpometacarpal joint involvement
- Technique
- Excision of hook of hamate
- ORIF
- Prognosis is fairly favorable with preserved range of motion, grip strength
Return to Play
- Physician discretion depending on surgical management
- Minimum 4-6 weeks
Complications
- Nonunion
- Malunion
- Carpometacarpal Arthritis
- Ulnar Nerve Injury
- Hypothenar Hammer Syndrome
- Flexor Digitorum Profundus tendon rupture
See Also
- Internal
External
- https://www.sportsmedreview.com/blog/diagnosing-hook-of-hamate-fractures/
- Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/
References
- ↑ Carroll RE, Lakin JF. Fracture of the hook of the hamate: Acute Treatment. J Trauma. 1993;34(6):803e805.