Clinical classification and treatment strategy of hamate hook fracture

Abstract

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.

Morphometry and morphology of hamate hook and its clinical implications

“…Xiong et al classified hamate hook fractures on the basis of the fracture sites into 3 types: Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of the hamate hook, and type III represented a fracture at the base of the hamate hook. In their study type II was the commonest fracture 15 . The weakest part of the hamate hook defined in the present study also lies in the middle part of the hamate hook.…”

Pulling Harder than the Hamate Tolerates: Evaluation of Hamate Injuries in Rock Climbing and Bouldering

“…Consolidation of the fracture site should be ensured and documented by CT, as small finger tendons can be frayed by the fracture site, which could ultimately lead to a rupture of the tendon. 3,6 Furthermore, the ulnar nerve can be irritated by loose fragments. 3,6,9,12,18 Of the 3 options for treating hamate hook fractures (excision of the fragments, open reduction and internal fixation, and cast immobilization), most reports indicate a preference for excision of the fragments.…”

“…Therefore, we recommend conservative therapy or open reduction and internal fixation to avoid fragment resection in type I fractures, especially in type I(II) or type I(III) cases in which relatively large fragments have been detected via CT. Xiong et al reported a high risk of nonunions, especially in type I (II) fractures with fracture sites in the center of the hook. 3 However, even patients with conservatively treated type I(II) fractures mostly experienced good healing. Nevertheless, physicians should be cognizant of the risk of nonunions; in such cases, a resection of the fragments and the residual base of the hook combined with a coverage of the fracture section with soft tissue is required.…”

Hook of the Hamate: The Spectrum of Often Missed Pathologic Findings

“…Fractures involving the hook are the most common type of hamate fracture [2]. The incidence of hook of the hamate fractures among professional and recreational athletes is much higher than in the general population and is posited to be on the rise owing to the increasing popularity of golf and racket sports [9, 12]. Several mechanisms cause hook of the hamate fractures, including blunt trauma, repetitive microtrauma, and avulsion injury.…”

“…4 and 5). Type 3 fractures account for over 75% of hook of the hamate fractures [4, 12]. Acute traumatic fractures of the hook often present with other fractures of the distal upper extremity, especially distal radial fractures [14] (Fig.…”