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 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 Description Subtypes Image Type I Hook of hamate fx (most common) • I - avulsion • II - middle of hook • III - base of hook Type II Body of hamate fx • IIA - coronal • IIB - transverse Presentation Symptoms ulnar-sided wrist pain and swelling Physical exam inspection focal tenderness over hamate Imaging Radiographs recommended views PA lateral ER oblique best view to see hamate body fractures carpal tunnel 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