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Hamate Fracture

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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

Differential Diagnosis

Carpal Bone Fractures

Differential Diagnosis Wrist Pain


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

Evaluation

Radiographs

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


See Also


References

  1. Carroll RE, Lakin JF. Fracture of the hook of the hamate: Acute Treatment. J Trauma. 1993;34(6):803e805.
Created by:
John Kiel on 18 June 2019 22:56:25
Authors:
Last edited:
13 October 2022 21:43:40
Categories:
Trauma | Osteology | Wrist | Upper Extremity | Fractures | Acute