UMEM Educational Pearls

Category: Orthopedics

Title: Hamate Fractures

Keywords: Hamate, Fracture, (PubMed Search)

Posted: 3/28/2009 by Michael Bond, MD (Updated: 3/28/2024)
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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

References

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