UMEM Educational Pearls

Title: Hamate Fractures

Keywords: Hamate, Fracture, (PubMed Search)

Posted: 3/28/2009 by Michael Bond, MD (Updated: 11/22/2024)
Click here to contact Michael Bond, MD

Hamate Fractures:

Typically the result of a direct blow, and the hook of the hamate is commonly fractured in batters or golfers.
Like the scaphoid, the hook is at risk for avascular necrosis and non-union of the hook.
Fractures of the body are more common than fracture of the hook of the hamate
On exam you will typically find:
- Increased pain with axial loading of ring (4th) and little finger (5th) metacarpals
- Most patients complain of pain and tenderness on ulnar side of palm or on the dorsoulnar aspect of the wrist.
- Pain also aggravated by grasping items.
Diagnosis
- Fracture often missed on routine AP & lateral films
- Most fractures can be diagnosed by plain films if you as for the "Carpal tunnel view"
- CT scan can also be used to see the fracture
Treatment
- Good Immobilization will often prevent avascular necrosis and allow early healing
  - Volar splint or short arm cast are usually adequate.
- Excision of the hook of the hamate provides similar results as an ORIF in those that have non-union or displaced fractures.
- Refer to orthopedics

Walsh JJ 4th. Bishop AT. Diagnosis and management of hamate hook fractures. Hand Clinics. 16(3):397-403, viii, 2000 Aug.