Hamate fracture

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Background

  • Must exclude injury to ulnar nerve/artery (hamate forms part of Guyon canal)
  • May involve the body, hook, or articular surface
    • Hook (common) - associated with interrupted swing of club, bat, or racquet (handle impacts hypothenar eminence)
    • Body (rare) - associated with fracture-dislocations of 4th/5th metacarpals

Clinical Features

  • Localized tenderness over hamate (elicited by compresing hypothenar eminence)

Differential Diagnosis

Carpal fractures

Evaluation

  • Standard and carpal tunnel views should be obtained
  • CT may be needed to identify occult fracture
Hamate fracture

Management

  • Hamate hook fracture
    • Compression dresing or Forearm volar splint
    • Nonunion is common and excision of bone may be necessary
  • Hamate body fracture
    • Stable: Forearm volar splint immobilization
    • Unstable (displaced, Guyon canal injury): splint immobilization and ortho referral

Disposition

See Also

References