Hamate fracture

Background

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

Clinical Features

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

Imaging

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

Hamate fracture

Differential Diagnosis

Carpal fractures

AP view

• Scaphoid fracture
• Lunate fracture
• Triquetrum fracture
• Pisiform fracture
• Trapezium fracture
• Trapezoid fracture
• Capitate fracture
• Hamate fracture

Management

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

See Also

• Carpal fractures