Hook Of Hamate Fractures Research Articles

Treatment of hamate hook fractures with rotating compression tension band fixation

Objective To report the experience of treating type Ⅱ and Ⅲ hamate hook fractures with rotating compression tension band fixation. Methods Five patients with type Ⅱ and Ⅲ hamate hook fractures were treated with open reduction and rotating compression tension band fixation from May 2010 to June 2014. Results All 5 patients were follow-up for 14 to 18 months, with an average of 15.6 months. All the patients were satisfied with the treatment outcomes. They recovered near normal range of motion and grip strength, and returned to their original job. According to the wrist function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the average values of active wrist joint motion of the 5 cases were 51° for extension, 55° for flexion, 15° for radial deviation, and 28° for ulnar deviation. Conclusion For patients with type Ⅱ and Ⅲ hamate hook fractures, open reduction and rotating compression tension band fixation is effective and recommended for wide clinical application. Key words: Hamate bone; Fracture fixation, internal; Rotating pressurized; Tension band

Hamate Hook and Pisiform Fractures

Though rare, hook of hamate (hamulus) fractures and pisiform fractures are serious injuries in the athlete that should not be missed or underestimated. Failure to promptly diagnose and treat these fractures may lead to serious complications including avascular necrosis, nonunion, tendon rupture, carpal instability, neurovascular compression, and arthritis. Hamulus fractures should be suspected in the athlete with persistent hypothenar hand, particularly those who use a bat, racket, or club. Complete hamulus excision after fracture has been shown to provide consistent pain relief and return to sport. Pisiform fractures are uncommon. Excision may provide benefit in the setting of a displaced fracture. Return to sport after any carpal fracture should focus primarily on the future health of the athlete, with future play only as a secondary aim.

Hamate Hook Fracture with Flexor Tendon Ruptures as a Golf Injury

Hamate Hook Fracture with Flexor Tendon Ruptures as a Golf Injury

III–1 Application of Low-Intensity Pulsed Ultrasound (LIPUS) for Carpal Fractures

Objective: There are few reports on the clinical application of low intensity pulsed ultrasound (LIPUS) for fractures of the hand. The aim of this study was to investigate the clinical outcomes of carpal fractures treated with LIPUS. Methods: We conducted a retrospective study to investigate the clinical characteristics of patients with the carpal fractures treated with LIPUS and their clinical outcomes. Results: Fifteen patients with carpal fractures underwent LIPUS in our institute. The average age was 31.6 years old. Ten scaphoid, 4 hamate (3 hook and 1 body), and 1 triangular fractures were included. One scaphoid fracture and 3 hamate hook fractures were treated conservatively, and the mean duration from injury to the application of LIPUS was 2.5 months. The other 11 patients received surgical treatment at an average of 26.5 months after injury, and the mean duration from surgery to the application of LIPUS was 2.2 months. Bone union was achieved in all 4 cases treated conservatively and in 9 of 11 cases treated surgically. The mean periods from LIPUS application to bone union was 4.3 months in the conservative treatment group and 4.2 months in the surgical treatment group. Discussion: It is expected that LIPUS is effective for carpal fractures because they are close to the skin surface. Although bone union was not achieved in 2 cases which received surgical treatment, the failure to achieve bone union is thought to be caused by insufficient screw fixation in one case and bone defect at the fracture site in another case. Similar to other fractures, LIPUS could be useful as adjuvant therapy for carpal fractures as long as adequate mechanical stability at the fracture site is achieved.

Clinics in diagnostic imaging (156)

The wrist is a common site of injury and the most frequently injured body part among professional golfers. A 37-year-old, right-handed male golfer presented with pain at the ulnar aspect of his left palm, which grew worse after an initial traumatic impact from the golf club handle. There was tenderness over the hypothenar eminence of the left palm. Computed tomography of the left wrist showed an undisplaced fracture through the base of the hamate hook. The golf-induced hamate hook fracture was managed conservatively, with cessation of physical activity involving the left hand and wrist for eight weeks. The patient made a full recovery. Repetitive trauma, exacerbated by improper wrist motion, leads to typical wrist injuries affecting golfers, such as ulnar impaction syndrome, de Quervain's disease, and tendinopathy affecting the flexor carpi ulnaris and extensor carpi ulnaris, all of which can be diagnosed on imaging.

HIGH INCIDENCE OF HAMATE HOOK FRACTURES IN UNDERWATER RUGBY PLAYERS: DIAGNOSTIC AND THERAPEUTIC IMPLICATIONS

Hamate hook fractures are rare injuries but appear to occur frequently in underwater rugby, the reason for which was investigated in this study. High-level underwater rugby players with hook fractures diagnosed during a five-year interval (2005-2010) were studied retrospectively. Medical data on these patients were reviewed for information on the mechanism of injury, type of fracture, radiological imaging, treatment, and outcome. In ten patients, hook fractures of the leading hand were confirmed by computed tomography, all of which were associated with specific injuries during underwater rugby games. Conservative treatment resulted in delayed healing or non-union, wherefore fragment excision and open reduction and internal fixation was performed in ten and five patients, respectively, while two patients declined surgery. After surgery, all patients were able to play underwater rugby again. In underwater rugby, hook fractures occur frequently due to high and repeated forces applied to the leading hand during games.

Two-Staged Tendon Reconstruction in Flexor Tendon Ruptures Secondary to Fracture of the Hamate Hook

We report a case of 2-staged reconstruction of flexor tendons ruptured spontaneously by attrition. A 49-year-old man presented with inability to flex the ring and little fingers of his left hand. Preoperative computed tomographic scans revealed fracture of the hamate hook. At the time of the operation, both the flexor superficialis and profundus of the little finger and the flexor profundus tendon of the ring finger were ruptured adjacent to the fracture site of the hamate. Because the flexor tendon rupture secondary to the fracture of the hamate is extremely rare, and surgical outcomes of previous reports are not satisfactory, a decision was made to perform 2-staged reconstruction of ruptured flexor tendons. The surgical result was excellent with complete restoration of full range of motion. This report describes for the first time to our knowledge, the technique, and rehabilitation of 2-staged tendon reconstruction in a patient with hook of hamate fracture.

CLINICAL OUTCOMES OF HOOK OF HAMATE FRACTURES AND USEFULNESS OF THE HOOK OF HAMATE PULL TEST

We report the usefulness of hook of hamate pull test (HHPT), described by Wright et al. in 2010, along with therapeutic outcomes of hook of hamate fractures. Eleven patients (two with fresh fractures and nine with nonunion) were studied. The fractures were diagnosed with HHPT for recently encountered 4 patients and a definitive diagnosis was made by a carpal canal view and a computed tomography (CT) scan. Treatment involved cast immobilization for one fresh fracture case, and bone fragment removal immediately over the hook for ten others. HHPT was positive in all the four cases. Union was achieved by conservative treatment, and hypothenar pain disappeared after surgery. Patients returned to work/sports two months postoperatively. HHPT was useful for diagnosing both fresh fractures and nonunion. If HHPT is positive, CT should be performed even if the fracture is obscure on a carpal canal view.

Clinical classification and treatment strategy of hamate hook fractures

Objective To explore the clinical classification of hamate hook fractures and the treatment strategies for different types of fractures.Methods Twelve cases of hamate hook fractures were retrospectively reviewed.According to the fracture sites and the prognosis,the hamate hook fractures were classified into 3 types.Type Ⅰ referred to an avulsion fracture at the tip of the hamate hook,while type Ⅱ presented as a fracture in the middle part of the hanate hook,and type Ⅲ represented a fracture at the base of the hamate hook.According to such a classification,in our series there was only 1 case of type Ⅰ,7 cases of type Ⅱ,and 4 cases of type Ⅲ.Threecases were treated conservatively,while 4 cases were treated with open reduction and internal fixation and another 5 cases with hamate hook excision.Pre-operative ulnar nerve injury co-existed in 3 cases (2 cases of type Ⅱ and 1 case of type Ⅲ).Flexor digiti minimi tendon injury co-existed in 2 cases (type Ⅱ),while pisiform-triquetral joint dislocation co-existed in 1 case (type Ⅱ).The results were evaluated with respect to the functional recovery,recovery time,the relationship between clinical classification,pre-operative complications and the treatment outcomes.Results The average follow-up time of this group was (8.4 ± 3.9) months,ranging from 4 to 16 months.Among the 7 cases treated with conservative measures or open reduction and internal fixation 2 had fracture non-union.Both cases were type Ⅱ fractures.The other 5 cases all achieved bone union.All the patients were satisfied at time of the last follow-up.Their pain scale and grip strength improved significantly after the treatment.All the pre-operative complications were relieved.The recovery time of patients treated with hamate hook excision was significantly shorter than those treated with other two methods.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.Conclusion The general therapeutic effects of hamate hook fractures are quite satisfactory.Type Ⅰ and type Ⅲ fractures without displacement can be treated with conservative measures.Type Ⅲ fractures with displacement can be treated with open reduction and internal fixation.Type Ⅱ fractures,due to the higher complication incidence,should be treated with hamate hook excision. Key words: Hamate bone; Fractures,bone; Treatment outcome; Follow-up studies; Clinical classification

Clinical classification and treatment strategy of hamate hook fracture

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.

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

Isolated fractures of the hamate hook can be treated by conservative or surgical means. Because nonoperative treatment is associated with high nonunion rates, surgical treatment with open reduction and internal fixation through a palmar approach is often preferred. The aim of this study was to refine surgical treatment of hamate hook fractures using a cannulated mini compression screw through a dorsal percutaneous approach. Artificial fractures of the hamate hook were created in five male cadaver hands under fluoroscopy. Using an ulnar approach, the hamate hook was fractured at the base (n = 3) and middle third (n = 2) of the hook using an osteotome. Each fracture was visualized by X-ray and computed tomography. Under fluoroscopy, the fracture was stabilized with a 1.1 mm K wire through a dorsal percutaneous approach which guided the introduction of a 3 mm diameter cannulated mini compression screw. The screw position was then controlled by X-ray and computed tomography. Percutaneous fixation of the fractured hook through the dorsal approach was achieved in all cases. Regardless of the fracture location, all fragments were adapted into anatomically correct positions. No displacement or disruption of the cortex of the hook was observed with central screw positioning. Minimal invasive repair of isolated hamate hook fractures through a dorsal percutaneous approach is feasible. The special properties of the cannulated mini compression screw allow optimal screw positioning and stable fixation without risk of diplacement or disruption of the hook fragment.

A small invasive operation with dorsal approach for old hamate hook fracture

A small invasive operation with dorsal approach for old hamate hook fracture

Case report of right hamate hook fracture in a patient with previous fracture history of left hamate hook: is it hamate bipartite?

BackgroundHamate hook fracture is a common fracture in golfers and others who play sports that involve rackets or sticks such as tennis or hockey. This patient had a previous hamate fracture in the opposing wrist along with potential features of hamate bipartite.Case presentationA 19 year old male presented with a complaint of right wrist pain on the ulnar side of the wrist with no apparent mechanism of injury. The pain came on gradually one week before being seen in the office and he reported no prior care for the complaint. His history includes traumatic left hamate hook fracture with surgical excision.ConclusionThe patient was found to have marked tenderness over the hamate and with a prior fracture to the other wrist, computed tomography of the wrist was ordered revealing a fracture to the hamate hook in the right wrist. He was referred for surgical evaluation and the hook of the hamate was excised. Post-surgically, the patient was able to return to normal activity within eight weeks. This case is indicative of fracture rather than hamate bipartite. This fracture should be considered in a case of ulnar sided wrist pain where marked tenderness is noted over the hamate, especially after participation in club or racket sports.

Attritional rupture of the small finger flexor tendons following local steroid injections of a hook of hamate fracture

Attritional rupture of the small finger flexor tendons following local steroid injections of a hook of hamate fracture

Aktuelle Behandlung der Hamulus ossis hamati-Fraktur

Hamate hook fractures can be treated conservatively or surgically, whereby fragment and fracture position, age of the fracture, associated injuries, and individual needs of the patient all influence the choice of the therapeutic procedure. Acute non-displaced fractures are frequently treated conservatively, while displaced fractures and nonunions undergo surgical treatment. We report our experience in diagnostic and therapeutic management of 14 hamate hook fractures. CLINICAL MATERIAL AND METHOD: During a three-year period, 14 patients (eleven men and three women) 21 to 73 years old (42.0 +/- 17.9 years) with fractures at the base of the hamate hook were treated at three hand surgery units. The retrospective study of all patients included a chart review, postoperative radiological imaging after one year, and clinical examinations with grip strength measurements after 18 to 34 months (27.8 +/- 4.9 months). In six patients (43 %), the acute fracture was immobilized in a lower arm cast for six weeks, while eight patients (57 %) were operated primarily. In five cases (36 %) excision of the fragment and in three cases (21 %) open reduction and internal fixation using a screw were performed. Of six patients treated conservatively, five developed nonunion after two to five months (3.0 +/- 1.2 months) with persistent pain and underwent secondary surgery. One patient was asymptomatic despite a nonunion and declined surgical treatment. In three cases the fragment was excised, while two patients underwent open reduction and internal fixation with a screw. All patients operated primarily were free of complaints three months after surgery. The success rate of surgical treatment (8/8) was therefore significantly higher than that after conservative treatment (1/6). Compared to conservative treatment of acute non-displaced hamate hook fractures, which is associated with a high risk of developing symptomatic nonunion, primary surgical treatment reliably yields a good clinical outcome. Here, results after fragment excision and open reduction and internal fixation are comparable.

Golf and Racquet Sports Injuries

There are specific injuries that are common in golf and racquet sports. These abnormalities have a predilection for specific structures as well and can be divided into two categories on the basis of etiology as either chronic repetitive injury or acute trauma. With golf injuries, upper extremity abnormalities prevail and include rotator cuff disease, epicondylitis, wrist tenosynovitis, and hamate hook fracture. Thoracolumbar spine pain can also occur. The order of frequency of these ailments is different for professional and recreational athletes. With racquet injuries, as in tennis, lower extremity injuries are more common and include medial gastrocnemius and Achilles tendon abnormalities, although shoulder, elbow, and wrist abnormalities may also occur. Knowledge of the biomechanics behind each sport is also helpful in understanding the pathophysiology of injury and in part explains the findings seen at imaging.

Therapeutic Alternatives in Nonunion of Hamate Hook Fractures

Symptomatic nonunion frequently results after conservative treatment of hamate hook fractures, emphasizing the need of appropriate surgical strategies. A retrospective analysis of 8 patients with nonunions treated by fragment excision or open reduction and internal fixation (ORIF) at 3 centers was performed. The literature was reviewed for treatment options, as bone grafting and low-intensity pulsed ultrasound. Although fragment excision is advocated as the "gold standard" in nonunion, reports on functional results are controversial, and recent anatomic and biomechanical studies of the hook challenge this opinion. In our patients, complete relief of symptoms and comparable functional results were observed after ORIF or fragment excision. Bone grafting could supplement ORIF in selected cases. Low-intensity pulsed ultrasound may evolve as a conservative treatment option. Several alternatives to hook excision are available aiming at complete anatomic and functional recovery of hamate hook nonunion. Further experience is needed before general recommendations can be formulated.

Hamate Hook Fracture in a 17-Year-Old Golfer: Importance of Matching Symptoms to Clinical Evidence

To describe the importance of correlating symptoms with objective clinical findings and appropriate diagnostic imaging in a patient with traumatic wrist pain. A 17-year-old golfer had persistent left wrist pain of 4 months' duration that began while playing golf. Approximately 1 week after injury, he was diagnosed with a scaphoid fracture and was splinted. He reported that his pain did not decrease with splinting or with subsequent physical therapy, and on dismissal from orthopedic care he could not use the wrist well enough to return to golf. The patient was found to have marked point tenderness at the hamate. Although plain-film radiography was negative, secondary computed tomography of the wrist showed a fracture to the hook of the hamate. A referral was made to an orthopedic surgeon and surgical excision of the hook of the hamate was recommended because of the failure of union at the fracture site. This case shows the significance of follow-up diagnostic imaging in a patient who does not respond as expected. In addition, it stresses the importance of the doctor of chiropractic in the diagnostic process, although the patient may have been treated and released by another physician.

Flexor Tendon Rupture Secondary to Golf-induced Hamate Hook Fracture-Case Report

The diagnosis of rupture of flexor tendon secondary to fracture of the hook of the hamate is rare but often delayed. Carpal tunnel views and CT scan of hand are helpful in making the diagnosis. We present two cases of spontaneous rupture of the flexor tendons of the little finger secondary to golf-induced hamate hook fracture. Hook of hamate fracture could be a result of repeat strokes of golf swing on the palm. The rupture of the flexor tendon favors the ulnar side due to abrasion of tendon on the fracture surface. Treatment includes excision of fracture fragment and repair of flexor tendon rupture with tendon graft or tenodesis. A strict rehabilitation program is essential to achieve good functional result.

Biomechanical evaluation of flexor tendon function after hamate hook excision

Purpose: Hamate hook fractures are uncommon injuries for which treatment is controversial. Excision of the hamate hook is considered to be the preferred method of treatment but the effects of hamate excision are not clearly delineated. The purpose of this study was to determine what effect, if any, excision of the hamate has on flexor tendon function. Method: The biomechanical effects of hamate hook excision on flexor tendon function were studied in fresh cadaveric forearm specimens with wrists fixed in 3 positions (neutral, 30° extension, 30° extension with 30° ulnar deviation). Flexor tendon force, flexor tendon excursion, and flexor tendon shift were evaluated. Results: Flexor tendon force decreased after hamate hook excision (11% in neutral, 14% in 30° extension, and 15% in 30° extension with 30° ulnar deviation). The flexor profundus tendons had a 7- to 11-mm increase in proximal tendon excursion after hamate hook excision depending on the position of the wrist, and the flexor profundus tendons of the small finger shifted 4 to 5 mm in ulnar direction. Conclusions: The hamate hook provides some biomechanical advantage for flexor tendon function and cadaveric changes in tendon force after its excision suggest that power grip may be decreased after hamate hook excision. (J Hand Surg 2003;28A:138–143. Copyright © 2003 by the American Society for Surgery of the Hand.)