Nondisplaced body fractures are treated in a short arm cast for 4 to 6 weeks until radiographic evidence of union. The inclusion criteria were 1 hook of hamate fracture, 2 competitive baseball players, and 3 surgical treatment of the injury. Anatomical variants of incomplete fusion of the hook of the hamate to the body os hamulus proprius may be confused with non union. Wrist pain is often seen in chiropractic practices. The hook of the hamate pull test is a dynamic test commonly used to assess for hook fractures.
Hook of the hamate fracture in golfers another distinctive golf injury is fracture of the hook of the hamate, one of the small bones of the wrist. How to manage triquetrum and hamate fractures in unusual. Carpal fractures in athletes excluding the scaphoid. Treatment of symptomatic displaced fractures, nonunion, and nondisplaced hook fractures. The fracture fragment and sharp spicules were re moved, and the rough surface of the body of the ha mate at the site of nonunion was smoothed. The two main types of hamate fractures are hook fractures type 1 and body fractures type 2. Although ulnar nerve compression has been associated with these fractures bishop and beckenbaugh, 1988, median nerve compression is an uncommon complication manske, 1978. Isolated hook of hamate fracture in sports that require a. One patient with a subacute fracture did not comply with treatment and had a painful nonunion. Pdf surgical excision of ununited hook of hamate fractures via the.
Hamate nonunion is frequently associated with irritation of the adjacent soft tissues. Resisted flexion of the fourth and fifth digits displaces the fracture and causes pain. The typical natural history patterns of missed hook of the hamate fractures include uncomplicated fracture healing, asymptomatic nonunion, and symptomatic nonunion or partial union. Displaced fractures require an anatomic reduction to prevent abnormal joint mechanics and softtissue irritation. The hook of the hamate fracture constitutes nearly 24% of carpal fractures and is typically caused by a direct blow, such as grounding a golf club or checking a baseball bat. Often, however, the displaced hook has to be surgically removed to take pressure off the ulna nerve. But the patients were generally satisfied with the results on the last followup. The hook shaped part of the hamate bone which protrudes outwards may break easily due to injury.
The most common history is of hitting the ground during a golf shot, with the handle of the club being forced into the palm of the left hand for a right handed golfer during the resulting jolt. Cronic nonunions may result in flexor tendon rupure and other complications. Surgical excision of ununited hook of hamate fractures via the carpal tunnel approach. Hamate body fractures are managed in a slightly different manner compared with hook fractures. Surgical excision of ununited hook of hamate fractures via. The occupational therapists approach part 2 e x p l o r i n.
Nondisplaced fractures within 3 months of injury initially receive conservative treatment with cast immobilization, 14, 21, 24. From the view of classification, the fracture of the hamate hook has a significantly high rate of nonunion p 0. If non union does occur excision or open reduction and. Nov 15, 2016 hamate hook hh stress fractures are rare, often presenting with misleading symptoms and easily overlookedmisdiagnosed. Because of the variable and occult presentation of the fracture, the diagnosis can be challenging. Fracture of the hook hamulus of the hamate hamate treatment may consist of splinting or casting if the fracture is seen very early after injury. Diagnosis of a hamate hook fracture with 3d reconstruction of. Computed tomography, hamate hook fracture, nonunion. If a symptomatic nonunion develops, the hook of hamate can be excised. This condition is known as fracture of hook of hamate. Nonoperative treatment of acute hamate hook fractures.
Symptoms are nonspecific and often mimic other clinical conditions, such as ulnar nerve entrapment or ulnar vessel thrombosis. An unrecognized and untreated hamate hook fracture may lead to a partial or complete rupture of the ivth or vth deep or superficial flexors fig. Further investigations, using 2d and 3d computerized tomography. Aug 27, 2010 we report the case of a missed fracture through the body of the hamate bone, only detected on a later, mistakenly taken 30 oblique xray view. Patients were sent a quickdash questionnaire regarding the outcomes of their treatment. Therapeutic alternatives in nonunion of hamate hook fractures. Case report of right hamate hook fracture in a patient. Non displaced fractures within 3 months of injury initially receive conservative treatment with cast immobilization, 14, 21, 24. Lessons to be learned from a missed case of hamate. If displaced or seen late with continued pain, numbness and tingling, or tendon irritation, surgery is usually performed to remove the broken bone fragment. We performed a retrospective study of 51 patients treated for hook of hamate fractures. Urch et al have reported that, among total carpal bone cases, the hamate accounts for only 2% of fractures, in contrast with the scaphoid which accounts for 70%. The fracture cannot always be detected clinically and standard radiographs do not always provide an overlapfree image of the hook of the hamate, so that fractures can easily be overlooked.
There were 15 type 1, 11 type 2a and three type 2b fractures. The hamate bone is one of eight carpal bones that conjoin and create your wrist. Dorsal percutaneous cannulated miniscrew fixation for fractures of the hamate hook. Treatment of hamate hook fractures includes immobilisation with casting, excision or reduction and internal fixation 4. Therapeutic alternatives in nonunion of hamate hook. Delayed diagnosis in nonunion of the body of the hamate. Ultrasound treatment of nonunion of the hook of the hamate. Retrospective analyses have demonstrated nonunion rates greater than 50% and as high as 8090% with conservative treatment. The purpose of this study was to evaluate the time to diagnosis and management of hook of hamate fractures in an era of advanced imaging.
Scaphoid and hook of hamate fractures move well pty ltd scaphoid fractures most commonly occur as a result of a fall onto an outstretched hand. Chronic symptomatic nonunion including chronic ulnarsided wrist pain, reduced grip strength, ulnar neuropathy secondary to nerve. Hook of hamate fractures in competitive baseball players. From the view of classification, the fracture of the hamate hook has a significantly high rate of non union p 0. Theres nothing like soaking in some glorious vitamin d while working on your swing. Coronal noncontrast undisplaced fracture through the base of the hook of the hamate. These fractures notoriously heal poorly and require quite significant immobilisation and rehabilitation following removal of the plaster cast. Scaphoid and hook of hamate fractures move well pty ltd. Highlevel underwater rugby players with hook fractures diagnosed during a fiveyear interval 20052010 were studied retrospectively. Aug 06, 2018 in the past, hamate hook fractures were treated conservatively with lower arm cast immobilization for 6 weeks, provided the fracture was diagnosed within 1 week of the injury. The patients were baseball players and had been injured as a result of hitting repeatedly. Golfs association with the beautiful outdoors is one of the best things about it. Fractures are the most common abnormality but account for less than 4% of carpal fractures 1, 2.
The blood supply to the hamate is variable with 70% have only vascular supply to the body predisposing hook fractures to nonunion. The hamate bone is one of eight carpal bones, it is a triangular bone, composed of a body and a hook hamulus, located on the ulnar side of the distal carpal row the hamate is a triangularshaped bone that forms part of the distal carpal row, articulating with the capitate radially, triquetrum proximally and fifth and fourth metacarpals distally. Fractured hamate bone from golf causes and treatment. Hamate hook nonunion initially mistaken for ulnar nerve. Symptoms are non specific and often mimic other clinical conditions, such as ulnar nerve entrapment or ulnar vessel thrombosis. The blood supply to the hamate is variable with 70% have only vascular supply to the body predisposing hook fractures to non union. There are 157 males, 25 females and 23 cases not be discerned. Fracture of the hook of the hamate is often not seen on xray studies, and fracture fragments can cause compression of adjacent structures, including the ulnar and median nerves and ulnar artery. Acute fractures of the hook of the hamate are frequently not seen on plain radiography. Concomitant hook of hamate fractures in patients with scaphoid. Ultrasound treatment of nonunion of the hook of the hamate in. Hook of hamate fracture radiology reference article.
Immobilisation has been an effective noninvasive treatment to a hamate hook fracture, however is most effective if the fracture is treated within the first week. Jun 04, 2015 the hook of the hamate pull test is a dynamic test commonly used to assess for hook fractures. Most commonly, fracture of the hook of the hamate occurs in sports involving racquets or clubs. Hamate hook fractures are rare injuries, comprising 2% to 4% of all carpal fractures. There was also a non displaced fracture line at the base of the fourth metacarpal bone. A 19 year old male presented with a complaint of right wrist pain on the ulnar side of the wrist with no apparent mechanism of injury. Ununited hook of hamate fracture on ct sagittal view. Tendon rupture of the flexor digitorum profundus of the. Immobilisation has been an effective non invasive treatment to a hamate hook fracture, however is most effective if the fracture is treated within the first week.
Pathologic conditions affecting the hook of the hamate are uncommon. These fractures occur frequently in individuals participating in sports activities involving racquets, bats, or clubs. Curvilinear incision centred over the carpal tunnel, then the transverse carpal ligament is identi. It may result in guyons canal syndrome differential diagnosis. Features of intrahamate vascularity and its possible. Sep 20, 2003 two cases of nonunion of the hook of the hamate were treated with lowintensity pulsed ultrasound. Fracture of hook of hamatecausessignssymptomstreatment. Classification and treatment of hamate fractures hand surgery. Diagnosis of a hamate hook fracture with 3d reconstruction. Lessons to be learned from a missed case of hamate fracture. Oct 24, 2019 nonoperative treatment of acute hamate hook fractures. Closed rupture of the flexor tendons of the little finger secondary to non union of fractures of the hook of the hamate published online. The most common history is of hitting the ground during a golf shot, with the handle of the club being forced into the palm of the left hand. Hook of hamate fractures are prone to nonunion, and their diagnosis is frequently delayed or missed.
Two cases of nonunion of the hook of the hamate were treated with lowintensity pulsed ultrasound. There was also a nondisplaced fracture line at the base of the fourth metacarpal bone. Pdf fragment excision for the treatment of hamate hook nonunion. Twentynine patients with hamate fractures were treated.
Wrist secrets the occupational therapists approach part 2. We subdivided type 2 fractures according to the fracture line into coronal, type 2a and transverse, type 2b. Gittlen, 1984, oblique views, bone scan, tomograms, and cat scan. The prevalence of unanticipated hamate hook abnormalities in. Since the hook of the hamate forms the distal and ulnar border of the carpal tunnel, it is understandable that fractures of the hamate. In most cases, the lead wrist, which is the left wrist in a right handed golfer, is most commonly fractured when the player strikes the ground, root or rock prior to striking the ball. Hamate hook fracture is a common fracture in golfers and others who play sports that involve rackets or sticks such as tennis or hockey. The primary etiology of the hamate hook fracture is athletics 74205,36%, and the second is fall and traffic accident 61205,30%. The flexor tendon was repaired by using the ulnar half slip of the flexor superficialis of the ring finger as an interposed tendon graft. The hook of hamate is particularly prone to fracture related complications such as non union due to its tenuous blood supply. Request pdf therapeutic alternatives in nonunion of hamate hook fractures symptomatic nonunion frequently results after conservative treatment of. The initial xrays showed fracture lines in the mid portion of the triquetrum and body of the hamate bone, which were passing obliquely to the radial side of the hook figure 1. Pdf fragment excision for the treatment of hamate hook. Isolated hook of hamate fracture in sports that require a st.
Aids to the diagnosis of hook fractures have been the carpal tunnel view abbitt and riddervold, 1987. These fractures may occur by direct trauma or indirect mechanisms. As the table 1 showing, in 74 cases the main reason of hamate hook fracture is sports and 33 cases of trauma other than sports. Case report of right hamate hook fracture in a patient with.
Hamate hook fractures are rare injuries but appear to occur frequently in underwater rugby, the reason for which was investigated in this study. But if you live in an area with cold winters, golfs outdoor nature can be one of the worst things about it too. Although the risk of hook nonunion is difficult to quantify given that most are identified as delayed or nonunions rather than acute injuries, one. Rupture of small finger flexor tendons secondary to. Hand xray appears nml ap view frequently is nondiagnostic with hamate fractures esp hook fx. Hamate is a bone, which is located on the outside or the little finger side of the wrist and has a hook shaped structure at the end. Treatment for most patients is excision of the small fracture fragment. Fractures of the hook of the hamate are more common and have been associated with diagnostic delay and delayed or nonunion. Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal. The hook of hamate fracture is usually caused by inappropriate positioning of the instrument where the end of a club or butt of a racquet exerts force on the hamate directly or when there is a shearing force applied by the extrinsic flexor tendons of the ring and little fingers on the hook of hamate. If a symptomatic non union develops, the hook of hamate can be excised at a later date. The hamate is the most ulnar carpal bone on the distal row.
Diagnosis and management of hook of hamate fractures. This case highlights some of the problems encountered with traditional xray views, and the need to consider oblique views as either standard procedure or as an adjunct where clinical suspicion remains high even in the presence of normal xrays. Nonunion was detected on computed tomography ct and was exposed to ultrasound for 20 min a day for 4 months. On a pa view three arcuate lines can be drawn along the carpal surfaces if there is disruption or widening of the spaces it may indicate carpal instability or damage to the ligaments ct scan is the preferred study for diagnosis of hook of hamate fractures.
Hook of the hamate fracture 24 % of all carpal fractures golf, baseball, and hockey mechanism of injury blunt trauma end of swing fall on extended wrist hook of hamate fracture presentation pain at the volar ulnar aspect of the hand worsened with a tight grip examination point tenderness pain with grip. The possibility of a hamate hook fracture should be considered even in the absence of tenderness over the hook or in the face of normal wrist imaging. Carpal fractures musculoskeletal medicine for medical. Anatomical variants of incomplete fusion of the hook of the hamate to the body os hamulus proprius may be confused with nonunion. Diagnosis and management of hook of hamate fractures assaf. Several professional baseball players have had the bone removed during the course of their careers. Yamazaki h, kato h, nakatsuchi y, murakami n, hata y. Despite its continued importance as a key anatomic landmark in modern medicine, the hook of the hamate remains a source of diagnostic errors in current clinical practice 3, 4.
The hook of hamate is raised from the body of the hamate bone. Several professional baseball players have had the bone removed during the course of. Coronal non contrast undisplaced fracture through the base of the hook of the hamate. Features of intrahamate vascularity and its possible relati. Finger tendon rupture secondary to fracture of the hamate. The clinical presentation is pain with palpation over the hook and painful grip. Fractures of the hook of the hamate are more common and have been associated with diagnostic delay and delayed or non union.
In most cases, the lead wrist, which is the left wrist in a right handed golfer, is most commonly fractured when the player strikes the ground, root or rock prior to striking. Diffinitively dx with carpal tunnel view radiograph if suspicion is high. Fractures of the hook can occur as a result of impact with the handle of a racquet or club during ball strike or from a fall on the volar, ulnar aspect of the hand. During a forceful swing, the base of the club can impinge against the hook of the hamate and cause a fracture fig. Their exact frequency is unknown due to the lack of clear data. Hook of the hamate hamate fracture ulnar nerve cicompression of the nerve at gguyons canal ulnar volar fcu palpate at ulnar volar wrist.
They occur from the hamate fracturing after blunt trauma, falls, and in sports player e. The hook is the particular part of that bone that protrudes toward your palm, and is vulnerable to injury from the club on a hard hit to the ground as the handle crosses right over the bony hook when. If nonunion does occur excision or open reduction and. Sep 03, 2018 hamate is a bone, which is located on the outside or the little finger side of the wrist and has a hook shaped structure at the end. Hamate fractures can be diagnosed incidental to other hand and wrist problems on ct. Treatment of hook of the hamate fracture depends on the acuity of diagnosis, degree of displacement, and location of fracture. A hook of hamate fracture is the term used for a break in the hook portion of the hamate bone. While fracture to the scaphoid or navicular is the most prevalent of wrist fractures, hamate hook fracture is the most frequent fracture in golfers. The standard wrist radiographs ordered for assessment of the carpal bones include ap, lateral and oblique views. We report the case of hamate nonunion that was only detected because of a flexor digitorum profundus tendon rupture in the little finger, associated with. In both cases pain at the hypothenar eminence disappeared, and bone union was. Wrist secrets the occupational therapists approach part 2 e x p l o r i n g h a n d t h e r a p e y x p l o r i n g h a n d t h e r a p y t r e a t men t 2 g o w w w.
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