Hamate fracture: Difference between revisions
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==Background== | ==Background== | ||
*Must exclude injury to ulnar nerve/artery (forms part of Guyon canal) | *Must exclude injury to ulnar nerve/artery (hamate forms part of Guyon canal) | ||
*May involve the body, hook, or articular surface | *May involve the body, hook, or articular surface | ||
**Hook | **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 | |||
**Body | |||
==Clinical Features== | ==Clinical Features== | ||
*Localized tenderness over hamate (elicited by compresing hypothenar eminence) | *Localized tenderness over hamate (elicited by compresing hypothenar eminence) | ||
== | ==Differential Diagnosis== | ||
{{Carpal fractures}} | |||
==Evaluation== | |||
*Standard and carpal tunnel views should be obtained | *Standard and carpal tunnel views should be obtained | ||
*CT may be needed to identify occult | *CT may be needed to identify occult fracture | ||
[[File:Hamate_Fracture.jpg|thumb|Hamate fracture]] | [[File:Hamate_Fracture.jpg|thumb|Hamate fracture]] | ||
== | ==Management== | ||
{{ | {{General 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== | ==See Also== | ||
*[[Carpal fractures]] | *[[Carpal fractures]] | ||
== | ==References== | ||
<references/> | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Latest revision as of 04:49, 18 September 2019
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
- Scaphoid fracture
- Lunate fracture
- Triquetrum fracture
- Pisiform fracture
- Trapezium fracture
- Trapezoid fracture
- Capitate fracture
- Hamate fracture
Evaluation
- Standard and carpal tunnel views should be obtained
- CT may be needed to identify occult fracture
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
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