Hook of Hamate and Pisiform Fractures in Basketball and Hockey Players

Abstract

li ni cs .c om Most fractures of the hook of the hamate present as established nonunions with symptoms of ulnarsided palmar pain and may have been treated for weeks or months as a sprain or tendinitis. Late complications can include flexor tendon rupture and ulnar nerve dysfunction. In the unusual case of an athlete who presents with an acute fracture, cast immobilization can be considered for up to 12 weeks with a good chance of healing. Casting would, however, preclude an early return to sport, and, in these cases I would allow the athlete to return to play and deal with nonunion at a later more convenient time with excision of the hook of the hamate.Hockey playersmay sustain acute fractures of the hook of the hamate fromadirect blow from thepuckormore commonly falling on the stick. Stress fractures of the hook of the hamate because of long hours of shooting practice are being seen increasingly more often. In these patients, the definitive treatment is excision of the hook of the hamate. Hockey players may return to playwith a protective pad in the glove when the skin has healed. Unprotected play is allowed as postoperative tenderness subsides. Hook of hamate fractures in basketball players are uncommon and usually occur due to a direct blow or a fall. These fractures can also be treated symptomatically, allowing the athlete to return to play as pain subsides. The ununited hook can be excised at the player’s convenience. After surgery, return to play is allowed with protection when the skin has healed. Soreness may persist for several weeks after surgery, and generally unprotected play is allowed after 6 weeks.