- Kevin deWeber, MD, FAAFP, FACSM
Kevin deWeber, MD, FAAFP, FACSM
- Family Medicine of SW Washington Residency
- PeaceHealth SW Medical Center
- Affiliate Associate Professor of Family Medicine
- Oregon Health and Science University
- Clinical Instructor of Family Medicine
- University of Washington School of Medicine
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
Upper extremity fractures are among the most common of the extremity injuries with carpal fractures accounting for 18 percent of hand fractures and 6 percent of all fractures [1-3]. Of these, fractures to bones of the distal row (trapezium, trapezoid, capitate, hamate) are less frequent than fractures of the bones of the proximal row (scaphoid, lunate, triquetrum, and pisiform). Hamate fractures account for 2 to 4 percent of the carpal fractures [4,5].
This topic will review fractures of the hamate in adults. An overview of carpal fractures and reviews of common wrist injuries in adults are presented separately. (See "Overview of carpal fractures" and "Scaphoid fractures" and "Distal radius fractures in adults".)
The anatomy of the wrist is discussed in detail separately; aspects relevant to hamate fractures are reviewed briefly below. (See "Anatomy and basic biomechanics of the wrist".)
The body of the hamate articulates distally with the bases of the fourth and fifth metacarpals, radially with the capitate and proximally with the triquetrum and lunate (image 1 and figure 1 and figure 2 and figure 3 and figure 4). The hook of the hamate (hamulus), which protrudes in a palmar direction, represents the distal border of Guyon's canal (figure 5), which contains the ulnar artery and nerve, and provides the attachment of the ulnar aspect of the transverse carpal ligament, which forms the roof of the carpal tunnel. Fractures involving the hamate, particularly the hook, can injure branches of the ulnar artery and nerve, and thus, it is important to ensure that blood flow and sensation is intact in the little and ring fingers. The ulnar nerve also supplies the intrinsic hand muscles, with the distal most innervation involving the dorsal interosseous muscle of the index finger (index finger abduction). (See 'Symptoms and examination findings' below and 'Complications' below.)
The blood supply to the hook of the hamate is variable and in some cases tenuous . Although the incidence of nonunion with fractures involving the hook is not known, the risk is increased in patients with a tenuous blood supply.
- Eiff MP, Hatch RL. Chapter 5: Carpal fractures. In: Fracture Management for Primary Care, 3rd, Saunders, Philadelphia 2011.
- Geissler W, Slade JF. Fractures of the carpal bones. In: Operative Hand Surgery, 6th ed, Green DP (Ed), Churchill Livingstone, Edinburgh 2011.
- Gaebler C, McQueen M. Carpus fractures and dislocations. In: Rockwood and Green's Fractures in Adults, 7th, Bucholz RW et al. (Ed), Lippincott Williams & Wilkins, Philadelphia 2010.
- Geissler WB. Carpal fractures in athletes. Clin Sports Med 2001; 20:167.
- Binzer, TC, Carter PR. Hook of the hamate fracture in athletes. Oper Tech Sports Med 1996; 4:242.
- Failla JM. Hook of hamate vascularity: vulnerability to osteonecrosis and nonunion. J Hand Surg Am 1993; 18:1075.
- O'Shea K, Weiland AJ. Fractures of the hamate and pisiform bones. Hand Clin 2012; 28:287.
- Bachoura A, Wroblewski A, Jacoby SM, et al. Hook of hamate fractures in competitive baseball players. Hand (N Y) 2013; 8:302.
- Scheufler O, Kamusella P, Tadda L, et al. High incidence of hamate hook fractures in underwater rugby players: diagnostic and therapeutic implications. Hand Surg 2013; 18:357.
- Van Demark RE Jr, Van Demark RE, Helsper E. Stress fracture of the hook of the hamate: a case report. S D Med 2015; 68:157.
- Lacey JD, Hodge JC. Pisiform and hamulus fractures: easily missed wrist fractures diagnosed on a reverse oblique radiograph. J Emerg Med 1998; 16:445.
- Wright TW, Moser MW, Sahajpal DT. Hook of hamate pull test. J Hand Surg Am 2010; 35:1887.
- Shimizu H, Beppu M, Matsusita K, et al. Clinical outcomes of hook of hamate fractures and usefulness of the hook of hamate pull test. Hand Surg 2012; 17:347.
- Carter PM, Hollinshead PA, Desmond JS. Hypothenar hammer syndrome: case report and review. J Emerg Med 2013; 45:22.
- Swanson KE, Bartholomew JR, Paulson R. Hypothenar hammer syndrome: a case and brief review. Vasc Med 2012; 17:108.
- Klausmeyer MA, Mudgal CS. Hook of hamate fractures. J Hand Surg Am 2013; 38:2457.
- American College of Radiology ACR Appropriateness Criteria, Acute Hand and Wrist Trauma, 2013. http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/AcuteHandAndWristTrauma.pdf (Accessed on October 01, 2015).
- Andresen R, Radmer S, Sparmann M, et al. Imaging of hamate bone fractures in conventional X-rays and high-resolution computed tomography. An in vitro study. Invest Radiol 1999; 34:46.
- Kato H, Nakamura R, Horii E, et al. Diagnostic imaging for fracture of the hook of the hamate. Hand Surg 2000; 5:19.
- Murthy NS, Ringler MD. MR Imaging of Carpal Fractures. Magn Reson Imaging Clin N Am 2015; 23:405.
- Komura S, Yokoi T, Nonomura H, et al. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am 2012; 37:469.
- Heo YM, Kim SB, Yi JW, et al. Evaluation of associated carpal bone fractures in distal radial fractures. Clin Orthop Surg 2013; 5:98.
- Kim JK, Shin SJ. A novel hamatometacarpal fracture-dislocation classification system based on CT scan. Injury 2012; 43:1112.
- Wharton DM, Casaletto JA, Choa R, Brown DJ. Outcome following coronal fractures of the hamate. J Hand Surg Eur Vol 2010; 35:146.
- Whalen JL, Bishop AT, Linscheid RL. Nonoperative treatment of acute hamate hook fractures. J Hand Surg Am 1992; 17:507.
- Watson HK, Rogers WD. Nonunion of the hook of the hamate: an argument for bone grafting the nonunion. J Hand Surg Am 1989; 14:486.
- Scheufler O, Radmer S, Andresen R. Dorsal percutaneous cannulated mini-screw fixation for fractures of the hamate hook. Hand Surg 2012; 17:287.
- Tomaru M, Osada D, Fujita S, Tamai K. Treatment of hook of the hamate fractures in adults using low-intensity pulsed ultrasound. Hand Surg 2014; 19:433.
- Sakuma Y, Iwamoto T, Momohara S. Ununited fracture of the hook of hamate treated with low-intensity pulsed ultrasound in an older middle-aged patient. Clin J Sport Med 2014; 24:358.
- Steinberg B. Acute wrist injuries in the athlete. Orthop Clin North Am 2002; 33:535.
- Devers BN, Douglas KC, Naik RD, et al. Outcomes of hook of hamate fracture excision in high-level amateur athletes. J Hand Surg Am 2013; 38:72.
- CLINICAL ANATOMY
- HISTORY AND MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- RADIOGRAPHIC FINDINGS
- DIFFERENTIAL DIAGNOSIS
- Fracture of other carpal bones
- Fracture-dislocations of carpal bones
- Distal radius fractures
- Metacarpal fractures
- Wrist sprain
- Hypothenar hammer syndrome
- INDICATIONS FOR SURGICAL REFERRAL
- INITIAL TREATMENT
- Basic care
- Cast placement and positioning
- FOLLOW-UP CARE
- RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS