UMEM Educational Pearls

Category: Airway Management

Title: Hook of hamate fracture

Keywords: had, wrist, carpal (PubMed Search)

Posted: 1/26/2019 by Brian Corwell, MD (Updated: 4/24/2019)
Click here to contact Brian Corwell, MD

Hook of hamate fracture

Often missed fracture despite classic history

A frequent athletic injury

Seen in stick sports (golf, baseball, hockey)

Typically caused by a direct blow (grounding a gold club)

https://upload.orthobullets.com/topic/6035/images/hamate_baseball.jpg

Patient presents with hypothenar pain and pain with tight gripping

https://upload.orthobullets.com/topic/6035/images/hamate_golf.jpg

Presentation may be subacute with longstanding wrist or palmer pain

Physical exam: Tender to palpation over hook of hamate

Specialized test: hook of hamate pull test

Supinated hand held in ulnar deviation. Ask patient to actively flex 4th and 5th digits against resistance at DIP.
 

https://www.youtube.com/watch?v=A-mjRnC1yWQ

 

Radiology: Consider adding carpal tunnel view to standard wrist series if diagnosis is suspected

CT sometimes needed to image the fracture

 

Tx: Immobilize in a short arm splint

References

https://eorthopod.com/news/new-test-for-sports-injury-of-the-hand/

 

https://www.orthobullets.com/hand/6035/hook-of-hamate-fracture