How are hamate fractures diagnosed and treated?

Updated: Nov 22, 2019
  • Author: David M Lichtman, MD; Chief Editor: Harris Gellman, MD  more...
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Answer

Answer

Fractures of the body of the hamate are much more uncommon than fractures of the hook of the hamate. [27, 28, 30, 32] Fractures of the body are often associated with fourth and fifth carpometacarpal (CMC) fracture-dislocations. Fractures of the body may occur as a result of an axial force that is transmitted through the metacarpals or a direct blow to the ulnar aspect of the wrist. Fractures of the hook of the hamate most often occur when one swings a baseball bat, golf club, or racquet. [58] The fracture may result from repetitive stress or a direct blow when a club or racquet strikes the ground.

The presentation of a body or hook fracture is similar. A high index of suspicion is required or a fracture might be easily overlooked. Firm pressure over the hook often causes tenderness. However, direct pressure over the dorsal body of the hamate can reproduce pain, particularly when the fracture is at the base of the hook. Grip weakness and pain with resistance to small-finger flexion are often present. The failure to diagnose and treat these fractures early may result in flexor tendon rupture and ulnar nerve palsy. In addition to routine radiographs, a carpal tunnel view should be obtained. CT should be considered when clinical findings indicate a fracture that is not present on routine radiographs.

Fractures of the hook and body are usually nondisplaced, and they can be treated with cast immobilization. Intra-articular fractures with a displacement greater than 1 mm are best treated with open reduction and internal fixation. Displaced fractures that involve the distal aspect of the hook often result in nonunion if they are not treated with open reduction and internal fixation.


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