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Hook of Hamate Fracture

Topic updated on 10/03/13 6:29pm
Introduction
  • Hamate fractures includes
    • hook of hamate fx (most common)
    • hamate body fx (very rare)
  • Present with history of blunt trauma to palm of hand
    • often seen in racquet sports
      • hockey
      • golf (miss ball and hit ground)
      • tennis
  • Must distinguish from bipartite hamate (will have smooth cortical surfaces)
Presentation
  • Symptoms
    • hypothenar pain
    • decreased grip strength
    • paresthesias in ring and small finger (ulnar nerve compression in Guyon's canal) and occasionally in thumb, index, middle and ring finger (median nerve compression in carpal tunnel)
    • motor weakness of intrinsics (ulnar nerve compression in Guyon's canal)
Imaging
  • Radiographs
    • recommended views
      • difficult to visualize fracture on AP 
      • best seen on a carpal tunnel view  
  • CT
    • best study to make diagnosis    
Treatment
  • Nonoperative
    • immobilization 4-6 weeks
      • acute hook of hamate fractures
      • body of hamate fx (rare)
  • Operative
    • excision of hamate fracture fragment
      • indications
        • chronic hook of hamate fxs
    • ORIF
      • indications
        • ORIF is possible but has little benefit

 

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Qbank (3 Questions)

TAG
(SBQ07.40) A 44-year-old man presents with ulnar-sided right wrist pain and mild constant tingling in the fourth and fifth digits after injuring his wrist while playing golf. Although pain and function have improved with conservative treatment 6 months following the injury, he still reports difficulty with his golf game. Which of the following should initially be obtained in this patient to aide in the diagnosis? Topic Review Topic

1. Bone scan of the wrist and hand
2. EMG study of the affected extremity
3. Carpal tunnel view radiograph
4. CT scan of the distal forearm and wrist
5. Contrast enhanced magnetic resonance angiogram

PREFERRED RESPONSE ▶
TAG
(OBQ11.130) A 24-year-old racquetball player presents after accidentally striking his racket against the wall during a match two months ago. He is tender to palpation over the hypothenar mass, and his pain is aggrevated by grasping. A radiograph and CT scan of his wrist are shown in Figures A and B. Which of the following treatment methods has been definitively shown in the literature to have a favorable outcome, and a high chance to return to pre-injury activities in patients with this injury? Topic Review Topic
FIGURES: A   B        

1. Activity restriction and continued monitoring
2. Open reduction and internal fixation
3. Casting for 6 weeks, followed by physical therapy
4. Corticosteroid injection and immediate return to play
5. Surgical excision

PREFERRED RESPONSE ▶
TAG
(OBQ08.23) A professional baseball player develops acute hand pain after fouling off a pitch. He is tender over the hypothenar eminence and has paresthesias in the ring and small fingers. Which radiographic view is most likely to reveal the pathology? Topic Review Topic

1. PA wrist
2. AP wrist in ulnar deviation
3. Lateral wrist
4. Carpal tunnel
5. Scaphoid

PREFERRED RESPONSE ▶
TAG
(OBQ04.21) A 24-year-old professional baseball outfielder reports persistent pain in the hypothenar region when batting for the past year. His CT scan is shown in Figure A. What is the recommended treatment? Topic Review Topic
FIGURES: A          

1. pisiform excision
2. hook of hamate excision
3. carpal tunnel release
4. decompression of Guyon's canal
5. open reduction and internal fixation

PREFERRED RESPONSE ▶



Cases

http://upload.orthobullets.com/cases/1974/ap_hand.jpg http://upload.orthobullets.com/cases/1974/oblique_hand.jpg http://upload.orthobullets.com/cases/1974/true_lat_hand.jpg
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Parker RD, Berkowitz MS, Brahms MA, Bohl WR
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