Hook Of Hamate Fractures Research Articles

Classification of Hamate Fractures: An Analysis of 247 Patients with Hamate Fractures.

Background: We devised a new classification of hamate fractures named the TOUCH classification. Each letter of this acronym depicts a fracture type - Type I (Transverse fracture), Type II (Open and/or complex fracture), Type III (Ulnar/medial tuberosity fracture), Type IV (Coronal fracture) and Type V (Hook fracture). Each fracture type was further divided into two or three subtypes (a, b, and/or c) based on degree of severity. The aim of this study is to classify the hamate fractures treated at our centre using this classification. Methods: A retrospective review of all patients with hamate fractures treated at our hospital between 2003 and 2022 was done. Patient data with regard to age, gender, mechanism of injury, injured limb and any associated injuries was collected. Hamate fractures were classified based on the TOUCH classification. Results: A total of 247 patients with hamate fractures were included. Patients in the age group of 20-40 years accounted for 73.6% of all fractures. Female patients accounted for only 6.9% of all fractures and 76.5% of women with hamate fractures were older than 40 years. The incidence of hamate fracture tended to increase with age in women. The most common mechanism of injury was a fall (69 patients). The injury involved the right upper limb in 195 patients. And 164 patients had associated injuries in the same upper limb. Type III (coronal fracture of the hamate body) accounted for 57.4%, followed by type V (hook of hamate fracture) in 26.7% of patients. Conclusions: The TOUCH classification could cover all kinds of hamate fractures. It is easy to remember and may guide surgeons in considering treatment options. Level of Evidence: Level IV (Diagnostic).

Understanding the Injury Mechanism in Hamate Hook Fractures by Investigating Fracture Morphologies: A Case Series Study.

Many studies have described hamate hook fractures resulting from direct force from sporting tools. However, several authors have reported fractures that did not occur during swing-related activities. This study aimed to understand the injury mechanism of fractures by investigating their morphologies. We selected patients with hamate hook fractures and collected data on computed tomography scans, injury causes, and how athletes handled sporting tools. We investigated 50 patients, and the study cohort included 32 patients who sustained injuries during sports: 24 during baseball (group A) and 8 during other sports (group B). Sixteen patients sustained injuries from falls (group C), and 2 had their hands crushed while using an industrial press machine (group D). In group A, most patients had a fracture line starting from the middle section of the radial side, accompanied by osteosclerotic changes in their lower hand. In group B, most patients had fracture morphologies similar to those of most patients in group A. The main morphology of fractures in group C was a transverse fracture at the base. Two patients in group D had minimal fragments at the tip of the hooks. Our results question the theory that most hamate hook fractures in athletes are caused by direct force exerted on the palm because the fracture morphology was different from that of patients injured by acute trauma from direct force. Instead, these fractures likely stem from an indirect mechanism involving repetitive force generated by the tendons and muscles acting on the hook.

Minimally invasive percutaneous screw internal fixation under robot navigation for the treatment of a hamate bone fracture

PurposeHamate fractures are rare fractures of the wrist and there is still no consensus on the optimal treatment for these fractures, especially hook of hamate fractures. Herein, the authors present a case study of a series of patients who were treated with closed reduction and minimally invasive percutaneous fixation under robot navigation.MethodsThis retrospective study reviewed 14 patients who had nondisplaced or minimally displaced hamate fractures on computerized tomography images and were treated using the treatment in our centre from November 1, 2019, to October 31, 2022. At the final follow-up, the flexion-extension and radial-ulnar range of motion of the wrist were measured, and the grip strength and pinch strength were measured. The pain of the wrist was assessed using the visual analogue scale (VAS). The Mayo wrist score reflected the recovery of the wrist.ResultsThe mean total operative duration was 40.1 min. All the fractures showed union at a mean of 3.0 months. At a mean follow-up of 23.3 months (range 6–36 months), the mean VAS score was 0.7, the average Mayo wrist score was 95, and the mean pinch strength and grip strength were 11.3 and 38.7 kg, respectively. The flexion-extension arc was 138.3°, the mean radial and ulnar deviation arc was 63.8°, and the mean pronation-supination arc was 172.3°. And the time of return to the original occupation was mean 4 months (3~6 months). There were no complications, such as infection or nerve paralysis.ConclusionsThis study suggests that nondisplaced or minimally displaced hamate hook fractures can be successfully treated by closed reduction and internal fixation with a headless compression screw with the assistance of robot navigation, and the small fragment of fracture can be accurately fixed with minimal iatrogenic injury.

Common Hand Injuries in the Baseball Player.

The list of potential hand and wrist injuries among baseball players is numerous and includes fractures, dislocations, strains, and sprains. The purpose of this review, however, is to highlight injuries to the hand and wrist which are either particularly common or unique to professional baseball players with an emphasis on diagnostic pearls and treatment principles. For many baseball-related hand and wrist injuries, descriptions of the pathophysiology, diagnosis, and treatment options are based on single institution case series. With the implementation of Major League Baseball's Health and Injury Tracking System, our understanding of the epidemiology of these injuries in professional baseball players has greatly improved. The most common injury requiring operative treatment is a hook of hamate fracture, and recent evidence increasingly supports fracture fragment excision for early pain-free return to sport. Fractures of the proximal phalanges of fingers, thumb phalangeal fractures, and UCL injuries are the most common indication for surgery of the digits. A4 pulley ruptures in pitchers and repetitive trauma to the vasculature of the palm and digits are relatively unique to professional baseball players and are frequently able to be managed non-operatively. While injuries to the hand and wrist are common, the median number of days missed due to such an injury was only 4 days among professional baseball players. Statements and Declarations" for inclusion in the published paper. Please note that submissions that do not include relevant declarations will be returned as incomplete.

Hook of Hamate Fractures.

Hook of hamate fractures are uncommon injuries with unclear prevalence. Classic presenting symptoms include volar-ulnar hand/wrist pain and weakness in grip, with possible ulnar nerve paresthesias. Patient factors, such as activity level and desired return to work/sport, shape the most appropriate treatment regimen although excision of the hook has been adopted by most surgeons. Overall, once patients receive the correct diagnosis and are treated, good outcomes with high satisfaction rates are expected.

Ulnar-Sided Wrist Pain in the Athlete: Sport-Specific Demands, Clinical Presentation, and Management Options.

Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Triquetrum osteotomy to approach an otherwise inaccessible coronal malunion of the hamate

Fractures of the hamate are rare, and a clear treatment algorithm does not exist. Nonetheless, surgical treatment is generally recommended for displaced fractures using a dorsal approach. There is also a lack of data on hamate malunion. We present a case of a 28-year-old female with a coronal malunion of the hamate and hamate hook fracture. Because the triquetrum prevented direct access to the fracture, we planned and undertook a transtriquetral coronal osteotomy based on three-dimensional computed tomography imaging data. After removing the bone callus, reduction was possible with subsequent fixation. We recommend performing a transtriquetral osteotomy to treat an otherwise inaccessible fracture or malunion of select hamate fractures.

Progression of Hamate Hook Stress Reactions in Elite Baseball Players.

Background:Hamate hook fractures can occur as a result of repetitive contact with the knob of the bat used in the sport of baseball. Hamate hook excision has resulted in excellent outcomes and return to sport (RTS) in elite baseball players. The ideal treatment for hamate stress response before the development of a fracture line is unknown.Purpose:To report the outcomes of elite baseball players with hamate bone edema.Study Design:Case series; Level of evidence, 4.Methods:We reviewed the medical records of all elite baseball players with hamate bone edema consistent with a stress response at 2 institutions. Players were eligible for inclusion if they played collegiate or professional baseball at the time of initial injury, had magnetic resonance imaging (MRI) showing hamate bone edema, and had no radiographic evidence of acute fracture lines at initial presentation.Results:A total of 4 players with a mean age of 22.8 years were included. All injuries occurred in the nondominant hand. All athletes had normal initial wrist radiographs and MRI showing hamate edema but no fracture line. Patients returned to play as tolerated and developed an acute injury at an average of 25.8 days (range, 10-56 days) from the initial presentation. Repeat radiographs demonstrated acute hamate hook fractures in all 4 (100%) athletes. All 4 athletes underwent hamate hook excision. There were no postoperative complications. All athletes returned to sport at their previous level of competition at a mean of 5.3 weeks (range, 3.6-7.3 weeks).Conclusion:There is a high rate of hamate bone edema progression to acute hamate hook fracture in elite baseball players, with 100% RTS at preinjury level after hamate hook excision. We therefore recommend against prolonged rest. Continuation of play with hamate bone edema followed by hamate hook excision for acute fracture limits the time missed and obtains a faster RTS in elite baseball players.

Hollow screw in treatment of basilar part fracture of hamate hook

To explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook. Five patients with basilar part fracture of hamate hook, aged 24-47 years (mean, 31 years) were treated with open reduction and hollow screw fixation between June 2015 and February 2019. There were 4 males and 1 female. The causes of injury were athletic injury in 3 cases, falling injury in 1 case, and crushing injury in 1 case. Among them, 1 case was combined with sensory disturbance of one and a half fingers on the ulnar side of the palm. The grip strength of the affected side was significantly decreased when compared with that of the healthy side in all patients. The intervals between injury and surgery were 3-8 days (mean, 4.2 days). Postoperative follow-up was conducted regularly to measure the grip strength of the affected and healthy fingers and the total motion of ring and little fingers of the affected side. Darrow criteria was used to evaluate the effectiveness. All the incisions healed by primary intention. All the patients were followed up 6-32 months (mean, 16 months). X-ray films showed that the basilar part fracture of hamate hook reached bony union, and the healing time was 2.0-3.5 months (mean, 2.2 months). At last follow-up, the grip strength of the affected side was (35.80±3.76) kg, showing no significant difference when compared with healthy side [(36.00±4.94) kg] ( t=0.094, P=0.930); and the total motion of ring and little fingers of the affected side was (529.0±8.9)°, which was significantly different from that before operation [(232.0±34.7)°] ( t=18.108, P=0.000). In 1 patient with ulnar nerve injury, the two-point discrimination of the innervation area was 4 mm, and the pain sensation and temperature sensation returned to normal. Assessed by Darrow criteria, the results were excellent in 4 cases and good in 1 case. For the basilar part fracture of hamate hook, hollow screw fixation can obtain secure reduction and fixation and provide sustained compression and counter-rotation for the broken end of fracture, thus allowing early joint motion and promoting fracture healing and recovery of wrist function. It is a relatively good method for the treatment of basilar part fracture of hamate hook.

A case of scaphoid fracture combined with hook of hamate fracture

A case of scaphoid fracture combined with hook of hamate fracture

Epidemiology and Impact of Hand and Wrist Injuries in Major and Minor League Baseball.

Background: Professional baseball players are at risk of acute and chronic injuries to their upper extremities. Methods: Major League Baseball's Health and Injury Tracking System, a prospective injury surveillance system, was used to identify and characterize all hand and wrist injuries sustained by all Major League Baseball (MLB) and Minor League Baseball (MiLB) players during the pre-, regular, and postseason throughout 2011-2016. Injuries were included if they resulted in at least 1 day out of play and were sustained during standard baseball activities. Days missed were defined as the time between injury and the first time in which a player was cleared to return to play. Results: During the study period, there were 4478 hand and 1748 wrist injuries throughout MLB and MiLB, which resulted in a total of 105 246 days out of play. This was equivalent to the length of 575 individual MLB player seasons, and the mean days missed per injury was 17 days. Most injuries were traumatic in nature, with 43% (n = 2672) of players injured after being hit by a baseball that mainly occurred during batting (n = 2521; 40%). Injuries that most frequently required surgical intervention were hook of hamate fractures (72%) and scaphoid fractures (60%). Conclusions: Understanding the epidemiology and impact of hand and wrist injuries in MLB and MiLB players may lead to improved management of these injuries and reduce time away from play. Most importantly, preventive measures and/or enhanced protective gear may be developed to minimize these types of injuries in MLB and MiLB.

Unusual Wrist Injury Presentation in a Football Player

HISTORY: 17-year-old high school football player presented for sideline evaluation with right wrist pain. The injury occurred when he was tackled and had his wrist twisted and caught under another player. His coach kept him in the game and after one more play, his teammates called out for medical attention. He had diffuse swelling and pain along the ulnar aspect of the distal forearm and wrist. He was placed in a volar splint and sent to the emergency department where x-ray imaging of the wrist was read by radiologist as normal. The athlete followed up in clinic four days later. He continued to have pain, restricted range of motion, and decreased strength. Review of systems was otherwise normal. Past medical history was unremarkable. PHYSICAL EXAMINATION: Wrist examination showed moderate diffuse swelling but no ecchymosis or deformity. He had tenderness along the ulnar aspect of the distal wrist. There was no tenderness at the anatomic snuff box or scaphoid tubercle. Range of motion was limited in all directions, especially in supination. Strength was 4+/5 in all motions except for supination, which was 3+/5. Special tests including triangular-fibrocartilage complex grind, Watson’s, and Finkelstein’s were equivocal. Sensation to light touch was intact. Radial pulses were equally palpable bilaterally. DIFFERENTIAL DIAGNOSIS: 1) Ulnar styloid or hook of hamate fracture. 2) Distal radioulnar joint injury. 3) TFCC injury. 4) Scapholunate or lunotriquetral dissociation. TESTS AND RESULTS: Initial x-rays at ED were read as normal. Repeat x-rays were concerning for volar ulna dislocation. MRI without contrast showed volar dislocation of the ulna. FINAL/WORKING DIAGNOSIS: Radioulnar joint dislocation with volar displacement of ulna. TREATMENT AND OUTCOMES: 1. Orthopedic hand surgery referral. Given the length of time since initial injury, closed reduction was performed under general anesthesia. 2. Long arm cast with the forearm in supination position for 4 weeks. Repeat x-rays demonstrated maintenance of reduction. After cast removal, the patient returned to football with a removal wrist splint.

Minimally Invasive Fixation With a Volar Approach Using a Cannulated Compression Screw for Acute Hook of Hamate Fractures

Optimal treatment of acute hook of hamate fractures (HHF) remains controversial. Isolated acute HHF can be treated nonsurgically or surgically (with excision of the hook or open reduction internal fixation). The authors present the functional outcomes of a case series of patients who were treated with minimally invasive volar fixation for acute HHF. This retrospective study reviewed 6 patients with nondisplaced acute HHF treated with a minimally invasive volar approach and cannulated mini-screw fixation. The development of postoperative complications (tendon and ulnar nerve lesions), pain evaluated using a visual analog scale, and radiological union evaluated on computed tomography scan is reported. Wrist range of motion and grip strength were measured bilaterally. Mayo Wrist Score and Quick-Disabilities of the Arm, Shoulder, and Hand were assessed. All outcomes were measured at 1, 2, 3, and 6 months after surgery. Fixation of HHF through the volar approach was achieved in all cases with no complications. The clinical and radiological union rate was 100%. All patients were able to return to their work or hobbies after an average of 7 weeks. This study suggests that acute HHF can be treated successfully by open reduction internal fixation using a volar approach with minimal morbidity and complications, a good union rate, and a fast return to daily activities. Therapeutic V.

Computerized tomographic prediction of flexor tendon injuries complicating hamate hook fractures.

We reviewed computerized axial tomography of 28 patients with hamate hook fractures who had surgical resection of the hook. We analysed the relationship between the fragment height ratio, fragment gap, and intraoperative findings of the tendons. We determined whether parameters in the images can predict complication of tear or disruption of the flexor tendons to the ring or little fingers. Of 28 patients, 16 had fragment height ratios between 50-74; ten among them had worn (eight patients) or ruptured (two patients) flexor tendons. Nine of the ten patients had fragment gaps greater than 2 mm. The remaining 12 patients had fragment height ratios between 75-100 and had intact tendons. We conclude that a fragment height ratio greater than 75 and fragment gap less than 2 mm in computer tomography may rule out tear or disruption of the flexor tendons of the ring and little fingers after hamate hook fractures, and a fragment height ratio between 50-74 with fragment gap greater than 2 mm indicates a high risk of flexor tendon tear or disruption. Level of evidence: IV.

Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?

ObjectiveThe aim of this study was to evaluate the outcomes of open reduction and internal fixation (ORIF) in hamate hook fractures and review the literature on this surgical procedure. MethodsWe report the outcomes of ORIF of hamate hook fractures in 13 consecutive patients (12 men and 1 woman; mean age: 32 years (range, 22–48 years)). In eight patients (61%) the fracture was associated with ulnar nerve neuritis in Guyon's canal. We assessed the following clinical data: age, sex, mechanism of injury, side of the injured hand and associated lesions, fracture classification, average time from injury to correct diagnosis, surgical technique, complications, and length of follow-up.All patients underwent radiological imaging, including standard radiographs in two planes (anteroposterior and lateral projections), and a CT study. Functional outcomes evaluated were pain, range of motion, grip strength, Disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score. ResultsThe mean follow-up was 36 months (range, 12–144 months). All 13 cases were treated with ORIF of the hook of the hamate. Mean VAS pain score was 5 preoperatively (4–9) and 1 (0–2) postoperatively. All patients returned to pre-injury level and only one patient felt pain on activity. Preoperative modified Mayo wrist score was 51 and the postoperative value was 94. All outcomes scores improved significantly from preoperative values. The patients who participated in sports postoperatively were able to do so at or near pre-injury levels. Postoperative average range of wrist motion was 76° in extension, 71° in flexion, 14° in ulnar deviation, and 21° in radial deviation.Mean grip strength in the hand with the hook fracture was 58 kg compared with 53 Kg in the unaffected hand. All patients returned to their pre-injury level of functioning after 10–12 weeks and there were no complications. Analysis of grip strength revealed values comparable with the unaffected hand. ConclusionORIF of hamate hook fractures is a safe and effective technique to restore normal grip strength and return to pre-injury level. In cases of ulnar nerve neuritis, neurolysis of the deep palmar branch is mandatory. Level of evidenceLevel IV, Therapeutic study.

Interposition Tendon Graft and Tension in the Repair of Closed Rupture of the Flexor Digitorum Profundus in Zone III or IV

We report the results of interposition tendon grafts using the ipsilateral palmaris longus tendon in 12 patients with closed flexor digitorum profundus tendon ruptures in zone III or IV of 14 digits between June 2006 and October 2015. Before surgery, 2 patients were diagnosed with closed tendon ruptures that occurred after nonunion of hamate hook fractures. The other 10 patients were diagnosed with spontaneous tendon ruptures of unknown cause. In 2 of the 10 patients with spontaneous tendon rupture, the cause of the rupture was not found. In the other 8 patients, there was rough surface with deficient overlying soft tissue on the radial side of the hamate hook. In all cases, the ruptured flexor digitorum profundus was reconstructed by applying overtension on the tendon graft, causing greater flexion than for the other normal digits. Hamate hook excision was also performed on 10 subjects with abnormalities. Postoperatively, the patients were followed for an average of 22.5 months (range, 12-64 months). At the final follow-up, the mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 5.7 (range, 3.3-8.3). There were excellent results in all 14 digits according to Strickland and Glogovac criteria. The mean total active motion was 167 degrees (range, 160-180 degrees). There were no surgical complications, including infection, adhesions, or tendon rerupture. There were excellent clinical results with the interposition tendon graft using palmaris longus for closed tendon rupture in zone III or IV of the hand. Applying overtension to the grafted tendon appears to be beneficial.

Concomitant hook of hamate fractures in patients with scaphoid fracture: more common than you might think

ObjectiveThe scaphoid is the most commonly fractured carpal bone. The presence of a concomitant hook of hamate fracture is of particular relevance given that it is often occult on routine wrist/scaphoid radiographs and that hook of hamate fractures are prone to symptomatic non-union, resulting in chronic ulnar wrist pain. Prompt diagnosis and immobilisation/fixation may minimise such complications. Our study is aimed at assessing the frequency of concomitant hook of hamate fractures in patients with scaphoid fractures.MethodsHook of hamate fracture is often occult on wrist/scaphoid radiographs. Hence, we identified all 2,568 CT and MRI studies performed to investigate scaphoid fracture at our institution from April 2005 to March 2016. Three hundred and twelve out of 2,568 cases were confirmed to have a scaphoid fracture. Images were then retrospectively reviewed by a Consultant Musculoskeletal Radiologist and Musculoskeletal Radiologist Trainee to assess for the presence of concomitant hook of hamate fracture and, if present, whether this was identified on initial reporting.ResultsConcomitant hook of hamate fracture was identified in 10.3% of cases (32 out of 312, 30 on CT, 2 on MRI); most were minimally/non-displaced. Sixty percent of fractures identified on CT were missed on the initial review (18 out of 30). Both cases identified on MRI had been initially reported.ConclusionScaphoid fracture is associated with higher than expected rates of concomitant hook of hamate fracture. Given the potential morbidity associated with hook of hamate fracture, this should be considered a review area when investigating scaphoid injury. These fractures are often minimally displaced, hence easily overlooked on CT. MRI may therefore be superior when investigating radiographically occult scaphoid fractures.

The Prevalence of Unanticipated Hamate Hook Abnormalities in Computed Tomography Scans: A Retrospective Study.

It is possible that some hamate hook fractures are not diagnosed or treated, thereby affecting the study of their natural history. Study of the prevalence of incidental hamate hook fractures, nonunions, and other abnormalities on computed tomography (CT) ordered for another reason could document a subset of undiagnosed and untreated hamate hook fractures which might change our understanding about the natural history. Reports of 2489 hand, wrist, and forearm CT scans for hamate hook abnormalities were searched. We excluded 19 patients with anticipated hamate fractures and 1 patient that had a hamate hook excision. Twenty-eight patients had an unanticipated hamate hook abnormality. There was a significant difference in the prevalence of incidental hamate hook abnormalities by sex but not by age. Among the 28 unexpected hamate hook abnormalities, there were 16 fractures of the base (12 acute, 1 nonunion, and 3 of uncertain age), 5 acute oblique fractures, and 7 tip abnormalities/ossicles. The patient with an incidental nonunion had a CT scan for wrist pain and was diagnosed with gout. All fractures involved a direct blow to the hand (distal radius or scaphoid fracture, or crush injury). The 7 patients with a hamate tip abnormality had a CT scan for a distal radius or metacarpal fracture, crush injury or wrist pain. Five acute fractures were treated operatively with excision and the other 23 fractures were treated nonoperatively. Hamate fractures can be diagnosed incidental to other hand and wrist problems on CT.

Internal Fixation of Hamate Hook Fracture by Dorsal Percutaneous Headless Compression Screw and Cortical Screw: A Technical Note

Internal Fixation of Hamate Hook Fracture by Dorsal Percutaneous Headless Compression Screw and Cortical Screw: A Technical Note

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

Hamate hook fractures are rare injuries, comprising 2% to 4% of all carpal fractures. Climbing athletes seem to be affected more frequently than others, as they strain the passive and active anatomical structures of their hands and fingers to maximum capacity during training or competing. This stress is transmitted to the hook of the hamate by tightened flexor tendons, which creates high contact pressure to the ulnar margin of the carpal tunnel. Injuries of the hamate hook, caused by contact pressure of the anatomical structures, are rare and occur nearly exclusively during climbing. We diagnosed 12 athletes with hamate hook fractures who presented with diffuse pain in the wrist joint, which occurred either during or after climbing. Radiographs or computed tomography revealed fractures in the hamate bones in most of the patients; therapy consisted of consequent stress reduction. Follow-up investigations found that all athletes were free of symptoms after 10.7 ± 5.1 (6-24) (mean ± standard deviation with range) weeks. Resection of the hamate hook was necessary in 3 patients. All patients regained their preinjury climbing level. 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.