Updated: 5/13/2021

Hamate Body Fracture

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  • Summary
    • Hamate Body Fractures are rare carpal fractures that can be associated with 4th or 5th metacarpal fractures.
    • Diagnosis is generally made with radiographs of the wrist but may require CT for confirmation.
    • Treatment is nonoperative for non-displaced fractures but displaced or intra-articular fractures require ORIF.
  • Epidemiology
    • Incidence
      • < 2% of all carpal fractures
  • Etiology
    • Pathophysiology
      • mechanism of injury
        • main cause for these lesions is a direct impact against a hard surface with a clenched fist
    • Associated conditions
      • 4th or 5th metacarpal base fractures or dislocations
        • present in ~ 15%
      • Hook of Hamate fractures
  • Anatomy
    • Osteology
      • triangular shaped carpal bone
      • composed of hook and body
    • Location
      • most ulnar bone in the distal carpal row
    • Articulation
      • 4th and 5th metacarpals
      • capitate
      • triquetrum
  • Classification
    • Milch Classification
      Type I
      Hook of hamate fx (most common)
         Type I-I
         Avulsion
         Type I-II
         Middle of hook
         Type I-III
         Base of hook
      Type II
      Body of hamate fx
         Type IIA
         Coronal
         Type IIB
         Transverse
  • Presentation
    • Symptoms
      • ulnar-sided wrist pain and swelling
    • Physical exam
      • inspection
        • focal tenderness over hamate
  • Imaging
    • Radiographs
      • recommended views
        • lateral
        • ER oblique
          • best view to see hamate body fractures
        • carpal tunnel
    • CT
      • usually required to delineate fracture pattern and determine operative plan
  • Differential
    • Hook of Hamate fracture
    • Pisiform fracture
    • Metacarpal shaft fractures
  • Diagnosis
    • Radiographic
      • diagnosis confirmed by history, physical exam, and radiographs
  • Treatment
    • Nonoperative
      • immobilization
        • indications
          • may be used for extra-articular non-displaced fracture
    • Operative
      • ORIF
        • indications
          • most fractures are intra-articular and require open reduction
        • technique
          • interfragmentary screws +/- k-wires for temporary stabilization
  • Techniques
    • Open Reduction Internal Fixation
      • approach
        • dorsal most common approach
      • fixation technique
        • fixation may be obtained with K wires or screws
      • postoperative care
        • immobilize for 6-8 weeks
  • Complications
    • Stiffness
    • Malunion
    • Infection
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