Review Question - QID 132

The history is typical of a hook of the hamate fracture, which is confirmed on the CT image. A carpal tunnel view radiograph of this injury is shown in Illustration A. It commonly occurs in baseball players and golfers. Physical exam findings include point tenderness at the hamate, ulnar nerve paresthesias (hemorrhage within Guyon's canal), and pain with axial load of ring and little fingers. For cases seen late, with few exceptions, the recommended treatment has been excision of the hook fragment. Marchessault provides a review of diagnoses and treatment for carpal fractures. They discuss the treatment of these injuries, indicating that acute, nondisplaced fractures may be placed in a cast, and excised if nonunion develops. The authors go on to say that certain investigators recommend excision of asymptomatic nonunions to minimize the risk for flexor tendon rupture.