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Introduction
  • A rare carpal fracture
  • Epidemiology
    • incidence
      • <2% of all carpal fractures  
  • Pathophysiology
    • mechanism of injury
      • main cause for these lesions is a direct impact against a hard surface with a clenched fist
  • Associated conditions
    • may be associated with 4th or 5th metacarpal base fractures or dislocations  
      • present in ~ 15%
Anatomy
  • Hamate Bone
    • 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 of Hamate Fractures
 Milch Classification
Type I  Hook of Hamate Fx (most common)     
Type II
 Body of Hamate Fx
 
 
Presentation
  • Symptoms
    • ulnar-sided wrist pain and swelling 
  • Physical exam
    • inspection
      • focal tenderness over hamate  
Imaging
  • Radiographs 
    • recommended views  
      • oblique radiographs (30°) are usually required to visualize fracture  
      • AP and lateral radiographs are less reliable 
    • additional views
      • carpal tunnel view radiographs
  • CT 
    • usually required to delineate fracture pattern and determine operative plan  
Treatment
  • Nonoperative
    • immobilization
      • indications
        • rarely may be used for extra-articular nondisplaced fracture
  • Operative
    • ORIF
      • indications
        • most fracture are intra-articular and require open reduction
      • technique
        • interfragmentary screws +/- k-wires for temporary stabilization 
Surgical 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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