Introduction Epidemiology incidence 2% of carpal fractures risk factors often seen in athletes 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 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 Imaging Radiographs recommended views PA lateral ER oblique carpal tunnel best view to see hook of hamate fracture findings PA view absence of eye sign or cortical ring normally produced by intact hook sclerosis in region of the hook 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
QUESTIONS 1 of 8 1 2 3 4 5 6 7 8 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (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? Review Topic QID: 3553 FIGURES: A B Type & Select Correct Answer 1 Activity restriction and continued monitoring 3% (122/3666) 2 Open reduction and internal fixation 4% (133/3666) 3 Casting for 6 weeks, followed by physical therapy 6% (214/3666) 4 Corticosteroid injection and immediate return to play 0% (14/3666) 5 Surgical excision 86% (3164/3666) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 5 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (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? Review Topic QID: 409 Type & Select Correct Answer 1 PA wrist 2% (50/2891) 2 AP wrist in ulnar deviation 4% (122/2891) 3 Lateral wrist 5% (142/2891) 4 Carpal tunnel 88% (2550/2891) 5 Scaphoid 1% (15/2891) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 4 Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK You have 100% on this question. Just skip this one for now. Take This Question Anyway (SBQ07SM.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? Review Topic QID: 1425 Type & Select Correct Answer 1 Bone scan of the wrist and hand 1% (15/2477) 2 EMG study of the affected extremity 17% (419/2477) 3 Carpal tunnel view radiograph 74% (1828/2477) 4 CT scan of the distal forearm and wrist 4% (97/2477) 5 Contrast enhanced magnetic resonance angiogram 4% (104/2477) L 2 Select Answer to see Preferred Response SUBMIT RESPONSE 3 You have 100% on this question. Just skip this one for now. Take This Question Anyway (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? Review Topic QID: 132 FIGURES: A Type & Select Correct Answer 1 pisiform excision 2% (38/2264) 2 hook of hamate excision 92% (2077/2264) 3 carpal tunnel release 0% (7/2264) 4 decompression of Guyon's canal 1% (12/2264) 5 open reduction and internal fixation 5% (113/2264) L 1 Select Answer to see Preferred Response SUBMIT RESPONSE 2
All Videos (2) Podcasts (0) Upgrade to View Premium Videos Upgrade to View Premium Videos Everything You Need to Know About the Hook of Hamate Richard Yoon General - Hook of Hamate Fracture 2/8/2015 873 views Upgrade to View Premium Videos Upgrade to View Premium Videos Hook of hamate palpation Richard Yoon Hand - Hook of Hamate Fracture 2/8/2015 1877 views
Hamate Body and Base of Ring Metacarpal Fracture Dislocation (C1974) Kenan Dehne Hand - Hook of Hamate Fracture 7/20/2014 219 1 10