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Activity restriction and continued monitoring
4%
181/4846
Open reduction and internal fixation
210/4846
Casting for 6 weeks, followed by physical therapy
6%
297/4846
Corticosteroid injection and immediate return to play
0%
19/4846
Surgical excision
85%
4110/4846
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The patients history and imaging are consistent with a subacute hook of the hamate fracture. This is demonstrated by the carpal tunnel view radiograph in Figure A, and confirmed by the CT scan of the wrist in Figure B. CT scan of the wrist is usually indicated to definitively diagnose these fractures. Current literature supports the most favorable results and ability to return to pre-injury activities with excision of the fracture fragment. There is little available literature reporting the results of open reduction and internal fixation of these fractures. Rettig et al review traumatic wrist injuries in athletes. With regards to treatment of hook of the hamate fractures, they state that ORIF and excision are the two viable treatment options in athletes. Of these, the literature supports fragment excision, which has an average return to sport time of 7-10 weeks. Welling et al determined which wrist fractures are not diagnosed with initial radiography, using CT as a gold standard and identified specific fracture patterns. In their series, they found that only 40% of hamate fractures were diagnosed on plain radiography, suggesting that CT should be considered after a negative radiographic finding if clinically warranted.
3.8
(17)
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