Hook of Hamate Fractures: Critical Evaluation of Different Therapeutic Procedures

Abstract

The treatment of choice in nondisplaced hook of hamate fractures is conservative, with lower arm splinting. Displaced fractures should be treated operatively, whereby excision of the fragment or open reduction and internal fixation are described. A hamulus ossis hamati fracture was verified in 14 patients (mean age, 42 years; range, 21 to 73 years) including 11 men and three women. In six patients (42.9 percent), conservative treatment was initiated immediately after trauma with a lower arm cast for 6 weeks, and eight patients (57.1 percent) were operated on primarily. In five patients (35.7 percent), the fragment was excised, and in three patients (21.4 percent), an open reduction and internal fixation was performed using a screw. In five of six patients treated conservatively, nonunion of the fracture with persisting clinical symptoms developed. All of those patients were treated operatively, whereby three patients underwent excision and two patients underwent screw fixation, which led to elimination of the symptoms. One patient was asymptomatic despite nonunion of the fracture and rejected surgery. All of the eight patients operated on primarily were asymptomatic 3 months after surgery. Therefore, the success rate of primary surgical treatment (eight of eight) was significantly higher compared with conservative treatment(one of six). Finally, all 14 patients were asymptomatic at late postoperative follow-up. The clinical outcome of patients with hook of hamate fractures treated conservatively was disappointing. Therefore, primary surgical treatment is recommended. In our patients, excision and open reduction and internal fixation led to comparable results.

Imaging the Post-Operative Wrist and Hand

“…7), or by excision of the fragment (Walsh and Bishop 2000) if a symptomatic non-union of the hook of the hamate is present. Nonunion is common in displaced fractures managed non-operatively, although long-term outcome may be no worse than those treated operatively (Scheufler et al 2005). Compression screw fixation generally achieves better fracture stability than fixation with Kirschner wires, although this does not necessarily correlate with outcome scores (Wharton et al 2010).…”

Sonographic Diagnosis of a Radiographically Undiagnosed Hook of the Hamate Fracture

“…In some cases, however, failure to fuse can occur and results in a separate small round ossicle (os hamuli proprium) located palmar to the hamate body. 1,2 With the pisiform, the HH constitutes the transverse carpal and pisohamate ligaments and the Guyon tunnel, which contains the ulnar nerve, artery, and veins. Within the tunnel, the nerve splits into a sensitive branch that follows a superficial course and a motor one that runs more deeply and courses along the ulnar margin of the hook.…”

Minimal Invasive Fixation of Hamate Hook Fractures Through a Dorsal Percutaneous Approach Using a Mini Compression Screw: An Experimental Feasibility Study

“…Excellent clinical results have been reported after hook excision in acute fractures [8]. However, other authors recommend a more individualized approach that considers fracture site, displacement, fragment size, delayed diagnosis and occupational activities [13,17,18]. Therefore, a palmar approach for open reduction and internal fixation (ORIF) using K wires or miniscrews has been suggested for the treatment of acute hook fractures [6,13], while hook excision has been advocated for displaced fractures, delayed diagnosis, and nonunion [6,9].…”

“…Isolated hamate hook fractures can be treated by conservative or surgical means [9][10][11][12][13]. Conservative treatment has been suggested for acute, nondisplaced fractures; however, this is associated with high nonunion rates [8,10,13,14].…”

“…Conservative treatment has been suggested for acute, nondisplaced fractures; however, this is associated with high nonunion rates [8,10,13,14]. Also, associated complications, like ulnar nerve palsy [15] and carpal tunnel syndrome [16], are more likely with fracture displacement.…”