Hamate Fracture

Other Names

• Hook of Hamate fracture
• Hamate avulsion fracture

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Background

• Hamate fractures represent about 2% of all carpal fractures

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Pathophysiology

• Mechanism
  • Direct compression of hook of hamate
  • Avulsion fracture of pisohamate ligament

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Risk Factors

• Sports
  • Racket sports
  • Baseball
  • Golf
  • Hockey

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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
  • Distal Radius Fracture
    • Barton's Fracture
    • Chauffer's Fracture
    • Colles' Fracture
    • Die-Punch Fracture
    • Radial Styloid Fracture
    • Smith's Fracture
  • Distal Ulna Fracture
  • Carpal Fractures
    • Scaphoid Fracture
    • Lunate Fracture
    • Triquetrum Fracture
    • Pisiform Fracture
    • Trapezium Fracture
    • Trapezoid Fracture
    • Capitate Fracture
    • Hamate Fracture
  • Essex Lopresti Fracture
• Dislocations
  • Wrist Dislocation (Radiocarpal and/or Ulnocarpal)
  • Carpometacarpal Joint Dislocation
  • Distal Radioulnar Joint Dislocation
  • Lunate Dislocation
  • Perilunate Dislocation
• Instability & Degenerative
  • Scapholunate Instability
  • Lunotriquetral Instability
  • Scaphoid Nonunion Advanced Collapse
  • Distal Radial Ulnar Joint Instability
  • Kienbocks Disease
  • Dorsal Wrist Impingement
• Tendinopathies & Ligaments
  • De Quervain's Tenosynovitis
  • Intersection Syndrome
  • TFCC Injury
  • Wrist Tendinopathies
  • Extensor Carpi Ulnaris Instability
• Neuropathies
  • Carpal Tunnel Syndrome
  • Pronator Teres Syndrome
  • Anterior Interosseus Nerve Syndrome
  • Posterior Interosseus Nerve Syndrome
  • Guyon Canal Syndrome
• Pediatric Considerations
  • Distal Radial Epiphysitis (Gymnast's Wrist)
  • Torus Fracture
• Arthropathies
  • Wrist Osteoarthritis
  • Rheumatoid Arthritis
  • Gout
• Cartilage
  • Osteochondral Defect
• Vascular
  • Hypothenar Hammer Syndrome
• Other
  • Ganglion Cyst of Wrist
  • Ulnar Impingement Syndrome
  • Infectious Tenosynovitis

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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

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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

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Classification

• Hook
• Body
  • Proximal pole
  • Medial tuberosity
  • Sagittal oblique
  • Dorsal coronal

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Management

Nonoperative

• Approximately 50% healing rate of waist and tip fractures due to poor vascularity
• 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

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Return to Play

• Physician discretion depending on surgical management
• Minimum 4-6 weeks

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Complications

• Nonunion
• Malunion
• Carpometacarpal Arthritis
• Ulnar Nerve Injury
• Hypothenar Hammer Syndrome
• Flexor Digitorum Profundus tendon rupture

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See Also

• Internal
  • Forearm Pain (Main)
  • Wrist Pain (Main)
  • Hand Pain (Main)
  • Hand and Wrist Anatomy (Main)
  • Physical Exam Wrist

External

• https://www.sportsmedreview.com/blog/diagnosing-hook-of-hamate-fractures/
• Sports Medicine Review Wrist Pain: https://www.sportsmedreview.com/by-joint/wrist/

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