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

Abstract

Climbers with an unspecific, diffuse pain in the wrist need to be examined by radiograph and, if radiograph is unclear, computed tomography or magnetic resonance imaging to detect or exclude the diagnosis of hamate fracture in order to avoid severe complications.

Fracture of the Hamate with Interposition of the Base of 5th Metacarpal, a Frequently Missed Injury

“…Conservative treatment with immobilization resulted in reduced pain and restored strength in 9 of the 12 patients however 3 patients had nonunion and needed surgical resection of the hamate hook. All athletes were free of symptoms after within 12 weeks and regained their pre-injury climbing level [12]. However coronal hamate fractures (type III injury) and with carpo-metacarpal disruption are successfully treated with open reduction and internal fixation with compression screws.…”

Non-union in a hook of hamate fracture of a skeletally immature baseball player

“…Among SM individuals, conservative treatment for HoH fractures has led to a high nonunion rate due to the limited blood flow to the hamate, motion at fracture site, displacement of fracture's fragment or the tension that is exerted by the piso-hamate ligament [3] , [10] . When there is a nonunion, studies have evidenced that bone fragment excision is the fastest and most effective treatment for SM athletes who wish to return to sports [6] . Based on these observations and the lack of surgical indications for SI patients, we provided the SM surgical alternative to our young patient.…”

“…Fractures of multiple carpals, including the hamate bone, has been described in limited reports of skeletally immature (SI) patients [4] , [5] , [6] . Due to its rarity, there is no consensus for HoH fracture treatment among SI individuals.…”

Stress Fracture of the Hamate Hook in a Water Polo Player

“…It was also noted that changes in the bowling technique and ball-drilling layout produced indirect forces on the hamate hook via the attached ligaments and strain on the flexor tendons. Lutter et al [3] have reported fractures of the hamate hook in 10 of 12 high-level rock climbers presenting with ulnar wrist pain without any history of direct trauma. Rock climbing does not usually cause direct trauma to the hamate hook; however, it was noted that the side-undercling position that is repetitively used by rock climbers forces the wrists into ulnar deviation and strains the flexor tendon and, thus, may serve as an indirect mechanism of the fracture by compressing the hamate hook.…”

“…In water polo, putting snap on the ball is needed to spin the ball while throwing it. Particularly, pushing and knuckling are unique motions used to throw a ball in water polo, which cause strong ulnar deviations of the wrist at ball release, similar to the side-undercling position of rock climbers [3]. Extreme deviation of the wrist likely puts strain on the flexor tendons producing strong forces on the hamate hook.…”