Fractures of the hamate bone of the hand are rare and are usually caused by direct blunt trauma or by repetitive traumas. Gunshot injury is a less common cause.
The fracture results in damage to the cortex and disruption of other soft tissue structures.
The hamate can be fractures through the distal articular surface, the body, or the hook. Distal articular fractures are accompanied by a fifth metacarpal subluxation. Body fractures occur with direct trauma or crush injuries to the hand. Hook of the hamate fractures are athletic injuries when the palmar surface of the hand is struck with an object. Sometimes avulsion fractures of the tip can occur.
The fracture may be complicated in the acute phase by neurovascular injury, or in the subacute or chronic phases by nonunion, malunion, infection, osteonecrosis, or osteoarthritis.
The diagnosis of this injury is usually made by a combination of physical examination and x-ray imaging.
Imaging includes the use of plain x-rays, and if indicated CT-scan, or MRI.
Hamate fractures that are nondisplaced can be treated with a short arm splint or cast for 6 weeks. Displaced fractures can be treated with Kirschner wires or screw fixation. Hook fractures can be treated with excision if there is a painful nonunion or displaced fragments.
The Normal Hamate The AP examination of the normal wrist shows the capitate in the second carpal row Courtesy Ashley Davidoff MD 45738c01 The Normal Hamate The coronal reconstruction of the wrist shows the normal hamate (H) Courtesy Ashley Davidoff MD Copyright 2011 46616b01
Coronal View of the Hamate – CTscan
Courtesy Ashley Davidoff MD 46616b01
3D rendering of the Hook of the Hamate
Courtesy Ashley Davidoff MD 46613c01.800
References
Davis MF, Davis PF, Ross DS. Expert Guide to Sports Medicine. ACP Series, 2005.
Elstrom J, Virkus W, Pankovich (eds), Handbook of Fractures (3rd edition), McGraw Hill, New York, NY, 2006.
Koval K, Zuckerman J (eds), Handbook of Fractures (3rd edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.
Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
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