- 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
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.
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- 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