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https://upload.orthobullets.com/topic/6035/images/hamate_golf.jpg
https://upload.orthobullets.com/topic/6035/images/hamate_baseball.jpg
https://upload.orthobullets.com/topic/6035/images/carpals.jpg
https://upload.orthobullets.com/topic/6035/images/hamate_lat.jpg
https://upload.orthobullets.com/topic/6035/images/hamate_anatomy.jpg
Introduction
  • Epidemiology
    • incidence
      • 2% of carpal fractures
    • risk factors 
      • often seen in
        • golf
        • baseball
        • hockey
  • Pathophysiology
    • typically caused by a direct blow
      • grounding a golf club
      • checking a baseball bat
  • Associated conditions
    • bipartite hamate
      • will have smooth cortical surfaces
Anatomy
  • Hamate
    • one of carpal bones, distal and radial to the pisiform
    • articulates with
      • fourth and fifth metacarpals
      • capitate
      • triquetrum
    • hook of hamate
      • forms part of Guyon's canal, which is formed by
        • roof - superficial palmar carpal ligament
        • floor - deep flexor retinaculum, hypothenar muscles
        • ulnar border - pisiform and pisohamate ligament
        • radial border - hook of hamate
      • one of the palpable attachments of the flexor retinaculum
      • deep branch of ulnar nerve lies under the hook
Presentation
  • Symptoms
    • hypothenar pain
    • pain with activities requiring tight grip
  • Physical examination
    • provocative maneuvers
      • tender to palpation over the hook of hamate  
      • hook of hamate pull test:
        • hand held in ulnar deviation as patient flexes DIP joints of the ulnar 2 digits, the flexor tendons act as a deforming force on the fracture site, positive test elicits pain
    • motion and strength
      • decreased grip strength
    • neurovascular exam
      • chronic cases
        • parasthesia in ring and small finger
        • motor weakness in intrinsics
Imaging
  • Radiographs 
    • recommended views
      • AP and carpal tunnel view
    • findings
      • fracture best seen on carpal tunnel view 
  • CT
    • indications 
      • establish diagnosis if radiographs are negative    
Treatment
  • Nonoperative
    • immobilization 6 weeks
      • indications
        • acute hook of hamate fractures
        • body of hamate fx (rare)
  • Operative
    • excision of hamate fracture fragment
      • indications
        • chronic hook of hamate fxs with non-union
    • ORIF
      • indications
        • ORIF is possible but has little benefit
Complications
  • Non-union
  • Scar sensitivity
  • Iatrogenic injury to ulnar nerve
  • Closed rupture of the flexor tendons to the small finger 
 

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