Hamate and hook of the hamate fractures musculoskeletal key. The diagnosis of an incomplete hook of the hamate fracture is difficult and often delayed. One patient with a subacute fracture did not comply with treatment and had a painful nonunion. Pdf diagnosis and management of hook of hamate fractures. Keywords hook of hamate fracture, nonunion, open reduction internal fixation.
Ununited hook of hamate fracture on ct sagittal view. For this reason ct is the radiological modality of choice in the diagnosis of hamate hook fracture. There was also a nondisplaced fracture line at the base of the fourth metacarpal bone. These fractures notoriously heal poorly and require quite significant immobilisation and rehabilitation following removal of the plaster cast. The hamate fracture is a commonly missed fracture due to the complexity of the anatomy of the carpal bone area and in this case 2, other distracting injuries associated with it. Their treatment depends on the displacement and type of fracture. Hamate is a bone, which is located on the outside or the little finger side of the wrist and has a hook shaped structure at the end. A us navy sailor was seen at an emergency department after falling on her outstretched hand. Article information, pdf download for diagnosis and management of hook of hamate. Further investigations, using 2d and 3d computerized tomography.
There is a paucity of data assessing the effect of a hook of hamate fracture on mlb players future athletic performance. Pdf isolated hook of hamate fracture in sports that require a strong. Utility of the radialdeviated, thumbabducted lateral. Hook of the hamate fracture journal of orthopaedic. Surgical excision of ununited hook of hamate fractures via the carpal tunnel approach. Hamate fractures are uncommon compared with scaphoid and distal radius fractures but, like these, often occur from a fall onto an outstretched hand. Curvilinear incision centred over the carpal tunnel, then the transverse carpal ligament is identi. Hook hamate fractures missed new test for pain medical. A computed tomography ct scan demonstrated a comminuted, nondisplaced dorsal hamate fracture. The hook of hamate, part of your hands skeletal structure, absorbs a lot of punishment every time your club strikes the ground. Hamate hook removal, microscrew internal fixation and. The aim of the study was to report characteristics of isolated hook of hamate fractures related to sports that require a strong grip. T1 nonoperative treatment of acute hamate hook fractures.
The first reported case of a hamate hook fracture was by milch. This case highlights some of the problems encountered with traditional xray views, and the need to consider oblique views as either standard procedure or as an adjunct where clinical suspicion remains high even in the. The patient was a 44yearold man who reported palmarulnarsided right wrist pain after injuring his wrist while playing golf. Diagnosis and management of hook of hamate fractures assaf. Carpal bones clinical anatomy in region of hamate hook plain radiograph of a normal wrist carpal tunnel view of the wrist hamate fracture oblique view fracture dislocation of the hamate hamate body fracture fracture of the hook of the hamate ct of hook of hamate fracture coronal ct of hamate fracture 3d reconstruction ct hamate fracture. Nonoperative comminuted hamate fracture journal of. Hook of the hamate fractures are common in sports with hand held equipment where a direct blow occurs to the palm of the hand for instance a baseball bat, golf club or tennis racquet striking the palm over the hook. To determine if mlb players who sustain hook of hamate fractures demonstrate decreased performance upon return to competition when.
The hook shaped part of the hamate bone which protrudes outwards may break easily due to injury. The purpose of this study was to evaluate the time to diagnosis and management of hook o f hamate fractures in an era of advanced imaging. Turns out that a fracture of the hamate is very common especially along the hook. The most common injury for golfers is a hairline fracture and. Trauma xray upper limb gallery 2 wrist hamate fracture. Hamate fractures account for 24% of carpal bone fractures.
Therapeutic alternatives in nonunion of hamate hook fractures. Body of the hamate fractures are related to higher energy trauma such as a punch and may be associated with concomitant carpal fractures and carpometacarpal dislocations. This condition is known as fracture of hook of hamate. To delineate a hamate hook fracture, a radiograph was obtained with maximal radial deviation of the wrist and maximal abduction of the thumb.
The injury often occurs when a golfer, baseball player, or. Fracture of the hook hamulus of the hamate hamate treatment may consist of splinting or casting if the fracture is seen very early after injury. However, the diagnosis and treatment of these injuries are often delayed and can severely handicap the performance of affected laborers or athletes. Lessons to be learned from a missed case of hamate. N2 six patients with acute and two patients with subacute nondisplaced fractures of the. The two main types of hamate fractures are hook fractures type 1 and body fractures type 2. Major league baseball mlb players are at risk of hook of hamate fractures. Performance outcomes after hook of hamate fractures in. This type of fracture most commonly occurs from repetitive microtrauma during certain sports including golf, hockey and baseball.
The hook of hamate fracture frequently occurs in sports where a firm grip is required, such as tennis, baseball, and golf. During a threeyear period, 14 patients eleven men and three women 21 to 73 years old 42. Isolated hook of hamate fracture in sports that require a. The treatment of hamate fractures varies on the basis of displacement and fracture location. The purpose of this study was to evaluate the time to diagnosis and management of hook of hamate fractures in an era of advanced imaging. Diagnosis and management of hook of hamate fractures. This view is easy and costeffective to obtain, and it may prove helpful in diagnosing suspected hamate hook fractures or locating the cause of unexplained ulnar wrist pain. Fractures of the hook of the hamate in baseball players usually result from a forceful swing of the bat and rarely from a slide into a base or by hitting a wall. Eleven patients two with fresh fractures and nine with nonunion were studied. Appropriately diagnosing and treating hook of the hamate fractures in a timely manner after injury can prevent longterm complications. This topic w it seems to us that you have your javascript disabled on your browser.
Hamate fractures comprise two completely different fracture entities. Nonoperative treatment of acute hamate hook fractures six patients with acute and two patients with subacute nondisplaced fractures of the hamate hook were treated with immobilization. Ct is also an excellent modality for evaluating hook fracture healing after treatment 22, 23. We subdivided type 2 fractures according to the fracture line into coronal, type 2a and transverse. We performed a retrospective study of 51 patients treated. Missing a fracture can lead to persistent pain from nonunion, ulnar nerve injury in guyon canal, and late rupture of little profundussuperficialis tendon. Nonoperative treatment of acute hamate hook fractures.
The hook of hamate fracture is usually caused by inappropriate positioning of the instrument where the end of a club or butt of a racquet exerts force on the hamate directly or when there is a shearing force applied by the extrinsic flexor tendons. The hook of the hamate pull test is a dynamic test commonly used to assess for hook fractures. The ulnar nerve hooks around the hook of hamate as it crosses towards the medial side of hand. Resisted flexion of the fourth and fifth digits displaces the fracture and causes pain.
A hook of hamate fracture is the term used for a break in the hook portion of the hamate bone in the wrist. Healing of nondisplaced hook fracture is less distinct and exhibits associated sclerosis 5, 11, 21. We subdivided type 2 fractures according to the fracture line into coronal, type 2a and transverse, type 2b. Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal. Excision of incomplete hook of the hamate fractures. We performed a retrospective study of 51 patients treated for hook of hamate fractures. Pdf on jul 14, 2015, t snoap and others published hamate fracture find, read and cite all the. They occur from the hamate fracturing after blunt trauma, falls, and in sports player e. We report our experience in diagnostic and therapeutic management of 14 hamate hook fractures. Hamate hook fractures are sometimes painless, and may be overlooked as the sensitivity of plain xrays is low at 50 90%, even when using carpal tunnel views. It is caused when blunt force is applied to the club face i.
If displaced or seen late with continued pain, numbness and tingling, or tendon irritation, surgery is usually performed to. To determine if mlb players who sustain hook of hamate fractures demonstrate decreased performance upon return to competition when compared with their performance before injury and that of their controlmatched peers. Body of the hamate fracture is a consequence of a direct blow over the hypothenar eminence or a considerably strong dorsopalmar compression. Hence, it is the authors opinion that the entire hook should be resected to the base of the hamate as the primary form of treatment in hook of the hamate fractures. Surgical excision of ununited hook of hamate fractures via. Fracture of hook of hamatecausessignssymptomstreatment. We studied the clinical and radiological findings in 12 patients who had fracture of the hook of the hamate. Mri also may provide informa tion on the degree of displacement of hook of the hamate fractures 1. Twentynine patients with hamate fractures were treated. We report the usefulness of hook of hamate pull test hhpt, described by wright et al. Hook of hamate fx most common i avulsion ii middle of hook iii base of hook.
These fractures should be managed with early excision, as. There were 15 type 1, 11 type 2a and three type 2b fractures. Mri also may provide information on the degree of displacement of hook of the hamate fractures 1. Patients were sent a quickdash questionnaire regarding the outcomes of their treatment. Initial management of hamate hook fractures can be conservative or surgical. Early casting immobilization for 68 weeks is essential.
To compare the effects of hamate hook removal, microscrew internal fixation and plaster fixation on fracture healing, work, life, and exercise recovery in patients with hamate hook fractures by retrospective case analysis. Avulsion fractures of the hook may also occur, as the hook of the hamate serves as an attachment point for three tendons opponens digiti minimi, flexor digiti minimi and flexor carpi ulnaris. Diagnosis and management of hamate hook fractures mayo. Evaluation of grip strength in hook of hamate fractures.
The hook is a curved, hooklike process that projects 12 mm distally and radially. Hook of hamate fracture radiology reference article. On ct images, nondisplaced hook of the hamate fracture appears as a sharply defined, thin, lucent line with cortical disruption. A hook of the hamate fracture is a fracture of the hamate on the ulnar side of the wrist and hand. These fractures are rare injuries constituting only 2% to 3% of all carpal fractures. Scaphoid and hook of hamate fractures scaphoid fractures most commonly occur as a result of a fall onto an outstretched hand. Hamate fractures mainly occur in two locations the hook of the hamate or the body. The patients with acute fractures were treated within 7 days of the injury, and those with subacute fractures were treated after 7 days. Hamate fractures are exceedingly rare clinical entities. We propose three radiographic signs of fracture that are readily seen on routine pa projections.
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