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Jasina A, Gräber S, Pourostad P, Schöffl V, Wagner M, Bayer T, Ohlmeyer S, Simon M, Lutter C. Biomechanical analysis of sport induced hamate stress fractures. Clin Biomech (Bristol, Avon) 2025; 126:106567. [PMID: 40414161 DOI: 10.1016/j.clinbiomech.2025.106567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2025] [Revised: 05/19/2025] [Accepted: 05/20/2025] [Indexed: 05/27/2025]
Abstract
BACKGROUND Bouldering is known for a high risk of hamate injuries. Over 75 % of sport climbers have signs of upper extremity overuse injuries. Training overload corresponds with bone edema and was linked to fractures of the hamate. To date, no study has addressed the pathomechanism of hamate fracture in climbing. The aim of this study was to investigate the stability of the hamate in a biomechanical setup under the tension of the flexor tendons. METHODS 20 fresh-frozen, unfixed human forearms were used for two test series. The test stand consisted of an modified isokinet. Tension was applied by a motor. The specimens were prepared and positioned in ulnar deviation for the first test series. Additionally, the flexor tendons of the specimens were replaced by a steel cable in the anatomical course for the second series. FINDINGS In the first series, no fracture occurred at the hamate. Causes for termination of these measurements were tendon rupture and failure of the suture in majority of the cases. In the second setup, tension was applied to the cable with an average maximum force of 1029.4 N [105 kg]. Fracture of the hamate occurred in two out of ten cases. The mean force measured in those cases was 1008.30 N [102.8 kg]. INTERPRETATION Our results shows that it is possible for flexor tendon's tensile load to cause hamate fracture. It must be considered in patients with ulnar localized pain in the wrist, especially with a suitable sports history. Its quick diagnosis allows further therapy and rehabilitation to be initiated.
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Affiliation(s)
- Andrzej Jasina
- Department of Orthopedics, University Medical Center, Rostock, Germany.
| | - Sina Gräber
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - Parisa Pourostad
- Department of Orthopedics, University Medical Center, Rostock, Germany
| | - Volker Schöffl
- Leeds Beckett University, Leeds, United Kingdom; Department of Radiology and Neuroradiology, Klinikum Fürth, Fürth, Germany; Department of Orthopedic and Trauma Surgery, Klinikum Bamberg, Bamberg, FRG, Germany; Department of Trauma Surgery, Friedrich Alexander University of Erlangen-, Nuremberg, FRG, Germany; Section of Wilderness Medicine, Department of Emergency Medicine, University of Colorado School of Medicine, Denver, USA
| | - Magdalena Wagner
- Department of Pathology, Friedrich Alexander University Erlangen-Nuremberg, Germany
| | - Thomas Bayer
- Institute of Radiology, Friedrich Alexander University, 91054, Erlangen-Nuremberg, Germany; Department of Radiology and Neuroradiology, Klinikum Fürth, Fürth, Germany
| | - Sabine Ohlmeyer
- Institute of Radiology, Friedrich Alexander University, 91054, Erlangen-Nuremberg, Germany
| | - Michael Simon
- Department of Anatomy and Cell Biology, Friedrich Alexander University Erlangen-Nuremberg, Germany
| | - Christoph Lutter
- Department of Orthopedics, University Medical Center, Rostock, Germany
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Tanaka T, Yoshii Y. Sixteen patients regarding the conservative treatment for hook of hamate fracture. World J Orthop 2025; 16:103795. [PMID: 40290603 PMCID: PMC12019143 DOI: 10.5312/wjo.v16.i4.103795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/23/2025] [Accepted: 03/06/2025] [Indexed: 04/17/2025] Open
Abstract
BACKGROUND Hook of hamate fractures occur either due to repetitive stress from gripping sports (e.g., golf, tennis, and baseball), leading to fatigue fracture, or as a result of trauma from falls or other injuries. The recommended treatment involves the excision of bone fragments to facilitate athletes' early return to sports; excision surgery is also performed in trauma cases. However, some patients prefer nonsurgical treatment options, and conservative treatment should be considered. AIM To present a case series of 16 patients conservatively treated for hook of hamate fractures. METHODS This study included 16 (11 males and 5 females; right side, 6 cases; left side, 10) patients who desired conservative treatment and could be followed-up until bone union was achieved. The average age of the patients was 49.6 (range: 24-72) years. The average time from injury to consultation was 4.3 (range: 0.2-21.4) weeks. The treatment involved 4 weeks of casting from the forearm to the metacarpophalangeal joint, followed by 8 weeks of splint fixation of the wrist. Follow-up computed tomography scans were performed every 4 weeks. RESULTS Bone union was achieved in all patients. The average duration of casting was 3.7 (range: 0-5) weeks and that of splint fixation thereafter was 8.6 (range: 0-28) weeks. The patients did not exhibit joint contractures or range of motion restrictions due to prolonged immobilization. CONCLUSION Conservative treatment with external fixation may be an option for hook of hamate fractures.
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Affiliation(s)
- Toshikazu Tanaka
- Department of Orthopedics Surgery, Kashiwa Hand Clinic, Kashiwa 2770005, Chiba, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ami 3000332, Ibaraki, Japan
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Luxenburg D, Patel N, Narasimman M, Weinerman J, Russo JP, Martin A, Minaie A, Dodds S. Return to Play After Hook of Hamate Fracture: A Systematic Review and Meta-Analysis. Hand (N Y) 2024:15589447241231303. [PMID: 38419427 PMCID: PMC11571494 DOI: 10.1177/15589447241231303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In athletes, a hook of hamate fracture is concerning in terms of time to return to sport and effect on performance upon return. This study aims to analyze the treatment of hook of hamate fractures in athletes to determine their rates of return to play, timelines of recovery, and performance level upon return to play. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform this analysis. The PubMed database was queried to perform the literature search. Data were pooled and analyzed. P values <.05 were considered significant. Data were analyzed using the Comprehensive Meta-Analysis software to determine heterogeneity. Twenty studies with 823 patients sustaining hook of hamate fractures that reported any competitive level of play were included in the analysis. Of the 823 patients, 778 (94.5%) were able to return to play with 91.2% (506/555) of patients demonstrating similar or improved performance. The mean time to return to play was 45 days (range: 21-168 days). Treatment included surgical excision for 787 patients (95.6%), open reduction and internal fixation for 18 patients (2.2%), stress reduction/casting for 13 patients (1.6%), and loss to follow-up or surgery refusal for 5 patients (0.6%). A very high number of athletes return to play following a hook of hamate fracture at the same or improved level of performance. In our study, the majority of injuries were treated with surgical excision of the fractured hook of hamate fragment. Most athletes returned to their sport at an average of 45 days.
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Affiliation(s)
- Dylan Luxenburg
- Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA
| | - Nikhil Patel
- Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA
| | - Manish Narasimman
- Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA
| | | | - Jean-Paul Russo
- Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA
| | - Anthony Martin
- Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA
| | - Arya Minaie
- Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA
| | - Seth Dodds
- Department of Orthopaedic Surgery, University of Miami, Miami, FL, USA
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Koslosky E, Elder G, Heath D, Brady C, Dutta A. Stress fractures of the hand and wrist in athletes. Injury 2024; 55:111218. [PMID: 38007972 DOI: 10.1016/j.injury.2023.111218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
Stress fractures of the upper extremity are reported less often than their lower extremity counterpart. This review aims to provide a comprehensive overview of an important and often missed diagnosis in pediatric athletes: hand and wrist stress fractures.
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Affiliation(s)
- Ezekial Koslosky
- University of Texas Health Sciences Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States.
| | - Gregory Elder
- University of Texas Health Sciences Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - David Heath
- University of Texas Health Sciences Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Christina Brady
- University of Texas Health Sciences Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Anil Dutta
- University of Texas Health Sciences Center San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
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Jie F, Hui Z, Dawei Z, Guiqian L, Rongjian S, Weiya Q. Minimally invasive percutaneous screw internal fixation under robot navigation for the treatment of a hamate bone fracture. BMC Musculoskelet Disord 2023; 24:929. [PMID: 38041112 PMCID: PMC10691140 DOI: 10.1186/s12891-023-06917-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 09/24/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE Hamate 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. METHODS This 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. RESULTS The 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. CONCLUSIONS This 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.
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Affiliation(s)
- Fang Jie
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, No. 11 Yangshan Road, Jinshanqiao Street, Xuzhou City, Jiangsu, 221004, Jiangsu, People's Republic of China
| | - Zhu Hui
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, No. 11 Yangshan Road, Jinshanqiao Street, Xuzhou City, Jiangsu, 221004, Jiangsu, People's Republic of China
| | - Zheng Dawei
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, No. 11 Yangshan Road, Jinshanqiao Street, Xuzhou City, Jiangsu, 221004, Jiangsu, People's Republic of China
| | - Liu Guiqian
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, No. 11 Yangshan Road, Jinshanqiao Street, Xuzhou City, Jiangsu, 221004, Jiangsu, People's Republic of China
| | - Shi Rongjian
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, No. 11 Yangshan Road, Jinshanqiao Street, Xuzhou City, Jiangsu, 221004, Jiangsu, People's Republic of China.
| | - Qi Weiya
- Department of Hand Surgery, Clinical Anatomy Laboratory, Xuzhou Renci Hospital, No. 11 Yangshan Road, Jinshanqiao Street, Xuzhou City, Jiangsu, 221004, Jiangsu, People's Republic of China.
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Bernstein ZL, Kirschenbaum JD, Gluck MJ, Hausman MR. An Analysis of Profundus Tendon Repairs After Distal Phalanx Amputation in a Cadaveric Model of Little Finger Superficialis Deficiency. J Hand Surg Am 2022; 47:902.e1-902.e6. [PMID: 34750047 DOI: 10.1016/j.jhsa.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/11/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The flexor digitorum superficialis tendon to the little finger (FDS-5) has been observed to have a higher degree of functional and structural variation than the FDS of other digits. FDS-5-deficient individuals necessarily rely on the flexor digitorum profundus tendon to the little finger (FDP-5) for flexion in their little fingers. FDS-5 deficient patients who experience a considerable injury to their FDP-5 are therefore at a risk of losing substantial little finger flexion. The purpose of this study was to evaluate the degree of flexion of the little finger at the metacarpophalangeal and proximal interphalangeal (PIP) joints in a cadaveric model of FDS-5 deficiency following amputation of the distal phalanx. METHODS Ten fresh-frozen cadaveric upper extremities with no prior trauma were used. Loads were applied to the FDP-5. Flexion at the PIP and metacarpophalangeal joints was measured in degrees with a goniometer. Little finger flexion testing was conducted under 5 different conditions: "baseline," "FDS-deficient," "no repair," "bone anchor" repair, and "A4 pulley" repair. RESULTS The results were as follows: (1) no significant differences in the flexion between baseline and FDS-deficient conditions; (2) a significant decline in PIP flexion in the no repair condition after FDP-5 division compared with the FDS-deficient condition; (3) a significant restoration in PIP flexion in both surgical repair groups compared with the no repair group; and (4) no significant differences in PIP flexion between the A4 pulley and bone anchor groups. CONCLUSIONS The bone anchor repair and the A4 pulley repair demonstrate similar abilities to restore flexion of the little finger at the PIP joint to baseline levels in this cadaveric model. CLINICAL RELEVANCE A clinical protocol is yet to be established for the surgical treatment in FDS-5-deficient patients requiring amputation of the distal phalanx of the little finger. This study aims to address this area of uncertainty by comparing the little finger flexion after 2 different approaches to profundus tendon reattachment that may be applicable in this clinical scenario.
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Affiliation(s)
- Zachary L Bernstein
- Leni & Peter May Department of Orthopaedics, Mount Sinai Hospital, New York, NY.
| | | | - Matthew J Gluck
- Leni & Peter May Department of Orthopaedics, Mount Sinai Hospital, New York, NY; Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael R Hausman
- Leni & Peter May Department of Orthopaedics, Mount Sinai Hospital, New York, NY
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Kuptniratsaikul V, Luangjarmekorn P, Kerr S, Vinitpairot C, Kitidumrongsook P. Grip strength after hamate hook excision and reconstruction surgery: A biomechanical cadaveric study. J Biomech 2022; 141:111221. [PMID: 35908472 DOI: 10.1016/j.jbiomech.2022.111221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/15/2022] [Accepted: 07/06/2022] [Indexed: 10/17/2022]
Abstract
Fractures of the hamate hook are common among professional athletes. The recommended treatment for this is hamate hook excision. The purpose of this study is to evaluate the hand grip strength after hamate hook resection at different levels. Six cadaver forearm flexor digitorum profundus tendons were loaded with 5- to 15-kilograms force and grip strength was subsequently measured. The same measurements were performed in five hamate hook conditions: normal, one-third, two-thirds, total hamate excision, and after perihamate ligament reconstruction. Multilevel mixed-effect models were used to calculate the scaling ratios after each surgical intervention and compared them to a normal hamate hook. A 25%, 36%, 47% reduction, and 7% increase (107% of baseline) in grip strength was found after one-third, two-thirds, total bone was resected, and after perihamate ligament reconstruction, respectively. The study shows an association between grip strength reduction and the level of hamate hook resection. Perihamate ligament reconstruction is recommended as it restores grip strength to normal.
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Affiliation(s)
- Vanasiri Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Pobe Luangjarmekorn
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Stephen Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Chaiyos Vinitpairot
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
| | - Pravit Kitidumrongsook
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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Sims LA. Upper Extremity Injuries in Rock Climbers: Diagnosis and Management. J Hand Surg Am 2022; 47:662-672. [PMID: 35256226 DOI: 10.1016/j.jhsa.2022.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
Rock climbing places substantial stress on the upper extremities and can lead to unique injuries not common to other sports. With increasing popularity of the sport, hand surgeons are expected to see more patients with these pathologies. An understanding of the sport, accurate diagnoses, and appropriate treatment protocols are critical to maintain climbers' competitive abilities.
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Affiliation(s)
- Laura A Sims
- University of Saskatchewan, Saskatoon Orthopedic and Sports Medicine Centre, Saskatoon Saskatchewan, Canada.
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Engler ID, Barrazueta G, Colacchio ND, Ruchelsman DE, Belsky MR, Leibman MD. Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play. Orthop J Sports Med 2022; 10:23259671211038028. [PMID: 35368440 PMCID: PMC8972935 DOI: 10.1177/23259671211038028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Hook of hamate fractures are relatively common in baseball players, but the proper diagnosis and surgical technique can be challenging. Outcomes after surgical excision, as well as optimal surgical technique, in elite baseball players have not been clearly established. Hypothesis: Excision of hook of hamate fractures with a technique tailored to elite professional and collegiate baseball players will lead to high rates of return to play within a short time. Study Design: Case series; Level of evidence, 4. Methods: We reviewed the cases of 42 elite athletes who underwent surgical excision of 42 hook of hamate fractures at a single academic hand surgery practice from 2006 to 2020. The athletes competed at the professional (n = 20) or varsity collegiate (n = 22) baseball levels and were treated using the same surgical technique tailored toward the elite athlete. The clinical history, timing of surgery, complications, and time to return to play were recorded for each patient. Results: All 42 patients underwent an excision of their hook of hamate fracture at a mean of 7.2 weeks (range, 0.5-52 weeks) from the onset of symptoms. All but one patient were able to return to full preinjury level of baseball participation within 6 weeks from the date of surgery, with a mean return to sport of 5.4 weeks (range, 3-8 weeks). Two patients returned to the operating room—1 for scar tissue formation causing ulnar nerve compression and 1 for residual bone fragment causing pain and ulnar nerve compression. Conclusion: Surgical excision of hook of hamate fractures in elite baseball players showed a very high rate of return to play within 6 weeks. Meticulous adherence to the described surgical technique tailored to athletes optimizes clinical outcomes and avoids complications.
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Affiliation(s)
- Ian D. Engler
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Ian D. Engler, MD, UPMC Freddie Fu Center, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3200 South Water St, Pittsburgh, PA, USA ()
| | - Gustavo Barrazueta
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - David E. Ruchelsman
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
- Hand Surgery PC, Newton, Massachusetts, USA
| | - Mark R. Belsky
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
- Hand Surgery PC, Newton, Massachusetts, USA
| | - Matthew D. Leibman
- Department of Orthopaedic Surgery, Tufts University School of Medicine, Boston, Massachusetts, USA
- Hand Surgery PC, Newton, Massachusetts, USA
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Gómez BO, Olea ÁG, Sierra VH. Percutaneous Dorsal Approach for Fractures of the Hook of the Hamate: A Less Common but Effective Option. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2021. [DOI: 10.1055/s-0041-1741322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Hook of hamate fractures are rare. The best treatment option is a source of debate; it ranges from conservative to surgical techniques, including resection of the hook or a volar approach followed by internal fixation. These techniques are not exempt from risk. Minimal invasive fixation using a dorsal percutaneous approach and a headless, cannulated mini screw is another option, although not commonly considered. We present a case series of patients who underwent this surgical technique.
Methods This is a retrospective review of four patients with nondisplaced hook of hamate fractures treated with dorsal percutaneous fixation. The evaluation included symptoms, physical examination, and radiological (radiographs, magnetic resonance imaging [MRI], and computed tomography [CT]) findings, as well as pre and postoperative strength (determined with a Jamar (JLW Instruments, Chicago, USA) hydraulic dynamometer) and quick disabilities of the arm, shoulder and hand (QuickDASH) scores.
Results The union rate was 100% with no associated complications. All patients resumed their preinjury activities 3 months after the surgery and reported they would undergo surgery again if needed.
Conclusion This retrospective study shows that safe treatment of nondisplaced hook of hamate fractures with percutaneous dorsal fixation is feasible, with excellent clinical outcomes. In any case, our sample is limited, and further studies are required.
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Affiliation(s)
- Borja Occhi Gómez
- Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Abstract
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.
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Affiliation(s)
- Andrea Tian
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA.
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Triplet JJ, Gellman H, Clause D, Halikis NM. The Effect of Thumb Immobilization on Fractures of the Hook of the Hamate: A Cadaver Study. Hand (N Y) 2020; 15:365-370. [PMID: 30124082 PMCID: PMC7225880 DOI: 10.1177/1558944718795307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Fractures of the hook of the hamate are rare. Nonoperative management has historically been immobilization in a short arm cast (SAC) without thumb immobilization with a high reported incidence of nonunion. The high prevalence of nonunion following nonoperative treatment may be secondary to motion at the fracture site. The transverse carpal ligament's attachment to the hook of the hamate results in movement at the fracture site during thumb motion. Methods: A cadaveric study using 8 fresh frozen cadaver arms amputated at the mid-humeral level was performed. Computed tomography (CT) imaging was used to assess the bony anatomy and assure no preexisting fractures were present. Osteotomy of the hook of the hamate was performed through a skin incision proximal to the hook of the hamate and the transverse carpal ligament. Each arm was then mounted in a jig designed to hold and stabilize the arm and hand in supination. CT scans were performed without cast immobilization with the thumb in extension and abduction, with SAC without thumb carpometacarpal joint immobilization, and SAC with thumb carpometacarpal joint immobilization. Results: Motion of the fractured hook of the hamate was found to occur in all noncasted specimens, greatest with base fractures. SAC without thumb immobilization had little to no effect in eliminating fracture motion. SAC including the thumb reduced fracture motion in all specimens. Conclusions: Previous poor experience with nonoperative management of fractures of the hook of the hamate may be partially due to inability to adequately immobilize the fracture fragment. Fracture motion of the hamate hook occurs during thumb movement, likely from traction on the fracture fragment by the transverse carpal ligament.
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Affiliation(s)
- Jacob J. Triplet
- OhioHealth Doctors Hospital, Columbus, USA,Jacob J. Triplet, OhioHealth Doctors Hospital, 5100 West Broad Street, Columbus, OH 43228, USA.
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杨 焕, 王 斌, 李 瑞, 张 荐. [Hollow screw in treatment of basilar part fracture of hamate hook]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:489-492. [PMID: 32291986 PMCID: PMC8171511 DOI: 10.7507/1002-1892.201908114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/03/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effectiveness of hollow screw for the treatment of basilar part fracture of hamate hook. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- 焕友 杨
- 唐山市第二医院手一科（河北唐山 063000）No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
| | - 斌 王
- 唐山市第二医院手一科（河北唐山 063000）No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
| | - 瑞国 李
- 唐山市第二医院手一科（河北唐山 063000）No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
| | - 荐 张
- 唐山市第二医院手一科（河北唐山 063000）No.1 Department of Hand Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China
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Ceccarelli R, Dumontier C, Camuzard O. Minimally Invasive Fixation With a Volar Approach Using a Cannulated Compression Screw for Acute Hook of Hamate Fractures. J Hand Surg Am 2019; 44:993.e1-993.e6. [PMID: 30797656 DOI: 10.1016/j.jhsa.2019.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 11/02/2018] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Romain Ceccarelli
- Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hopital Pasteur 2, Nice
| | - Christian Dumontier
- Centre de la Main, Urgences Main, Clinique les Eaux Claires, Baie-Mahault, Guadeloupe, France
| | - Olivier Camuzard
- Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hopital Pasteur 2, Nice.
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Lamas-Gómez C, Velasco-González L, González-Osuna A, Almenara-Fernández M, Trigo-Lahoz L, Aguilera-Roig X. Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary? ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:115-119. [PMID: 30638780 PMCID: PMC6506807 DOI: 10.1016/j.aott.2018.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 09/25/2018] [Accepted: 12/19/2018] [Indexed: 11/26/2022]
Abstract
Objective The 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. Methods We 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. Results The 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. Conclusion ORIF 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 evidence Level IV, Therapeutic study.
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Abstract
Background: Fractures of the hook of hamate in baseball players are significant injuries that can lead to pain and missed time from competition. The diagnosis is typically delayed because of the vagueness of symptoms and normal radiographic findings. Excision of the nonunited fragment has been supported as the primary treatment, but there are currently limited information and data on a timetable for return to competition after surgery. Purpose: To report on a large cohort of competitive baseball players with hook of hamate fractures treated with excision of the fragment and to assess the timetable for return to full athletic competition. Study Design: Case series; Level of evidence, 4. Methods: Competitive baseball players treated between 2012 and 2017 with hook of hamate excision for acute fractures or chronic fracture nonunions were retrospectively identified. All patients were treated by the same surgeon, and the time to return to full athletic competition was assessed. Return to play was defined as reaching the athlete’s preinjury level and being able to perform full sport activities. Results: A total of 41 baseball players were identified, all of whom were documented to have a chronic presentation of a nonunion or partial union. The population consisted completely of male athletes, with a median age of 21 years (range, 18-34 years). All patients were competitive athletes, with 12 professional baseball players, 17 collegiate baseball players, and 12 high school baseball players. All patients were treated with hook of hamate excision, with 7 patients undergoing concomitant procedures as indicated. The median time to return to play was 5 weeks (range, 3-7 weeks). The time to return to play was similar between professional, collegiate, and high school athletes. All athletes returned to their preinjury level of activity by 7 weeks postoperatively. Conclusion: This study confirms that excision of the fractured hook provides predictable, early return to play, with a limited complication rate.
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Affiliation(s)
- Andrew Burleson
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California, USA
| | - Steven Shin
- Kerlan-Jobe Orthopaedic Clinic, Los Angeles, California, USA
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Abstract
Injuries to the hands and wrist are common in athletes. Injuries include acute fractures, dislocations, ligamentous, and tendon injuries, as well as more chronic injuries such as sprains and strains. Complications in the treatment of sports injuries of the hand and wrist may be divided into 2 categories: incorrect or delayed diagnosis and iatrogenic injury related to treatment. This article highlights common sports injuries of the hand and wrist and their complications, and includes tips for successful management.
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Affiliation(s)
- Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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Evaluation of the pulley function of the hamulus of the hamate for the flexor tendons. Surg Radiol Anat 2018; 40:1013-1017. [PMID: 29713737 DOI: 10.1007/s00276-018-2034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of this study was to measure the curvature radii of the finger flexor tendons on CT acquired using tendon conditions to examine whether the hamulus of the hamate functions as a pulley of the flexor tendon. METHODS The subjects were 20 healthy volunteers (40 hands) (14 males and 6 females, mean age: 27.5 years old). Their hands were imaged in extension and flexion of the fingers on CT. The curvature radii of the little and middle finger flexor tendons at the hamulus of the hamate were calculated. RESULTS The curvature radii of the little and middle finger flexor tendons were 24.8 ± 7.3 and 327.1 ± 343.9 mm in finger extension, respectively, and 21.3 ± 5.3 and 265.1 ± 202.9 mm in finger flexion, respectively. The curvature radius of the little finger flexor tendon was significantly smaller than that of the middle finger flexor tendon in both finger extension and flexion (P < 0.01). CONCLUSIONS Our study suggested that the hamulus of the hamate functions as a pulley for the little finger flexor tendon.
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20
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Lutter C, Schweizer A, Hochholzer T, Bayer T, Schöffl V. Pulling Harder than the Hamate Tolerates: Evaluation of Hamate Injuries in Rock Climbing and Bouldering. Wilderness Environ Med 2016; 27:492-499. [PMID: 27793442 DOI: 10.1016/j.wem.2016.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/02/2016] [Accepted: 09/03/2016] [Indexed: 01/03/2023]
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Josipovic M, Bozic D, Bohacek I, Smoljanovic T, Bojanic I. Hamate hook nonunion initially mistaken for ulnar nerve compression: a case report with review of literature. Wien Klin Wochenschr 2016; 129:136-140. [PMID: 27848072 DOI: 10.1007/s00508-016-1114-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/12/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hamate hook (HH) stress fractures are rare, often presenting with misleading symptoms and easily overlooked/misdiagnosed. These fractures occur frequently in individuals participating in sports activities involving racquets, bats, or clubs. Symptoms are non-specific and often mimic other clinical conditions, such as ulnar nerve entrapment or ulnar vessel thrombosis. CASE REPORT A 17-year-old tennis player with no history of trauma presented with dominant hand weakness together with pain and paresthesia on the ulnar side, which exacerbated with tennis play. The patient was treated for ulnar nerve compression with activity cessation and rest for 2 months. After 6 months of persistent symptoms, the patient underwent open Guyon tunnel release, although preoperative electromyoneurography revealed no signs of nerve damage and bone scans showed a small area of increased uptake in the hypothenar region. Postoperatively, symptoms resumed and the patient reported to our department for a second opinion. Point tenderness over HH, hypothenar muscles hypotrophy, paresthesia, hand weakness and pain with ulnar deviation, and flexion of distal phalanges of the two ulnar fingers were observed. HH fracture was suspected. Computerized tomography scan revealed fractured HH and the patient underwent hook excision. One month postoperatively, the pain intensity reduced together with function and strength improvement; 2 months postoperatively, the patient was pain free and had returned to tennis. CONCLUSIONS In patients involved in racquet sports with hypothenar pain and paresthesia of the ulnar side of the hand, HH fracture should be suspected. Symptoms can mimic ulnar nerve entrapment and may lead to overlooking the correct diagnosis. Treatment of choice is fractured fragment excision.
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Affiliation(s)
- Mario Josipovic
- Department of Orthopaedic Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Salata 6-7, 10000, Zagreb, Croatia
| | - Dorotea Bozic
- Department of Gastroenterology, University Hospital Centre Split, Spinciceva 11, 21000, Split, Croatia
| | - Ivan Bohacek
- Department of Orthopaedic Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Salata 6-7, 10000, Zagreb, Croatia.
- Department of Anatomy and Clinical Anatomy, University of Zagreb School of Medicine, Salata 11, 10000, Zagreb, Croatia.
| | - Tomislav Smoljanovic
- Department of Orthopaedic Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Salata 6-7, 10000, Zagreb, Croatia
- The Elective Orthopaedic Centre, Epsom, Surrey, UK
| | - Ivan Bojanic
- Department of Orthopaedic Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Salata 6-7, 10000, Zagreb, Croatia
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Avery DM, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res 2016; 11:99. [PMID: 27633260 PMCID: PMC5025579 DOI: 10.1186/s13018-016-0432-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population. Main body The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided. Conclusion Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.
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Affiliation(s)
- Daniel M Avery
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA.
| | - Craig M Rodner
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
| | - Cory M Edgar
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
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Pan T, Lögters TT, Windolf J, Kaufmann R. Uncommon carpal fractures. Eur J Trauma Emerg Surg 2015; 42:15-27. [PMID: 26676306 DOI: 10.1007/s00068-015-0618-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
Fractures of the hand are frequently encountered with injuries to the phalanges and metacarpals comprising the vast majority. Fractures of the carpal bones excluding the scaphoid, however, are fairly uncommon. Despite the rarity of fractures of the remaining seven carpal bones, they can cause a disproportionate amount of morbidity from missed diagnosis due to their subtlety as well as their frequent association with significant ligamentous disruption or even other carpal bone fractures. Delayed diagnosis can result in inadequate fracture care, which places the wrist at risk of disabling sequelae. This review focuses on the current concepts of pathophysiology, diagnosis, and treatment of carpal fractures other than the scaphoid.
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Affiliation(s)
- T Pan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, USA.
| | - T T Lögters
- Department of Trauma and Hand Surgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - J Windolf
- Department of Trauma and Hand Surgery, University Hospital Duesseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - R Kaufmann
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, USA
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Abstract
Carpal fractures are uncommon, but if missed, can lead to morbidity and loss of function, especially in an athlete. Early diagnosis through physical examination, plain radiographs, and possibly advanced imaging is paramount. Treatment is specific to each fracture type, and return to play varies with each clinical scenario. This article organizes current knowledge of these potentially difficult fractures with a table of diagnoses and treatment guidelines.
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Affiliation(s)
- Ekaterina Y Urch
- Department of Hand, Upper Extremity and Microsurgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Steve K Lee
- Department of Hand, Upper Extremity and Microsurgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Ununited fracture of the hook of hamate treated with low-intensity pulsed ultrasound in an older middle-aged patient. Clin J Sport Med 2014; 24:358-9. [PMID: 24389626 DOI: 10.1097/jsm.0000000000000007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 63-year-old man presented with a complaint of left ulnar wrist pain after playing golf. Computed tomography was used to detect a fracture at the base of the hook of hamate. Low-intensity pulsed ultrasound without a splint for immobilization was started, and bone union was confirmed 12 months after the ultrasound treatment started. The patient returned to play golf without any symptoms or complications. The present case suggests that ultrasound treatment is effective for fractures of the hook of hamate even in an older middle-aged patient. Ultrasound treatment is more time consuming than other surgical treatments, but it can be an important, safe, and noninvasive therapeutic alternative to surgery for fractures of the hook of hamate.
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Naito K, Yoshikawa K, Kaneko K, Obayashi O. Hamate hook non-union treated with a break-away screw: a case report. ACTA ACUST UNITED AC 2014; 18:417-20. [PMID: 24156590 DOI: 10.1142/s0218810413720283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hamate hook non-union is a relatively rare, but on the increase. We encountered a 25-year-old male baseball instructor with hamate hook non-union, and treated it with debridement of the fractured region and osteosynthesis using a break-away screw. Splint fixation was applied for three weeks after surgery, and active/passive range of motion exercises were actively performed thereafter. Bone union was noted three months after surgery. Transient ulnar paralysis resolved, and the patient could return to the same sports activity as that before injury six months after surgery. Since break-away screws are capable of loading a strong pressure on the fractured region and these screws can be inserted by preparing only a surgical field for guide wire insertion, requiring no soft tissue dissection to prepare a region for applying fixation materials, break-away screws are useful for the fixation of small bone fragments and osteosynthesis in a deep surgical field.
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Affiliation(s)
- Kiyohito Naito
- Department of Orthopaedic Surgery, Juntendo University Shizuoka Hospital, Japan
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Klausmeyer MA, Mudgal CS. Hook of hamate fractures. J Hand Surg Am 2013; 38:2457-60; quiz 2460. [PMID: 23891177 DOI: 10.1016/j.jhsa.2013.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/01/2013] [Indexed: 02/02/2023]
Affiliation(s)
- Melissa A Klausmeyer
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA
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Abstract
BACKGROUND Baseball players are susceptible to a number of specific upper extremity injuries secondary to batting, pitching, or fielding. Fractures of the hook of hamate have been known to occur in batters. The purpose of this study is to present our experience with the surgical management of hook of hamate fractures and their short-term impact on the playing capability of competitive baseball players. METHODS A retrospective chart review was performed on patients with hook of hamate fractures between the years 2000 and 2012. The inclusion criteria were (1) hook of hamate fracture, (2) competitive baseball players, and (3) surgical treatment of the injury. Patient demographics, mechanism of injury, surgical treatment, and outcome were collected from the medical records. Information on return to play was collected from the Internet when applicable. RESULTS There were seven male patients that underwent eight procedures. The mechanism of injury was attributed to batting in six cases and rogue pitches in two cases. All surgeries consisted of hamate hook excision and ulnar tunnel decompression. One patient had concomitant carpal tunnel release. The median time between surgery and return to play was 5.7 weeks (range, 4.3 to 10.4 weeks). CONCLUSIONS The mechanism of hook of hamate fractures in baseball players is predictable, most often developing secondary to repetitive swinging. This injury may occur at all levels of competition. Ulnar tunnel decompression with hook of hamate excision provides good outcomes, with minimal complications and early return to play.
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Hamate hook nonunion treated with a hook plate: case report and surgical technique. Tech Hand Up Extrem Surg 2013; 16:194-7. [PMID: 23160549 DOI: 10.1097/bth.0b013e31826577f8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite of its rarity, hamate hook nonunion can cause several complications like tendon rupture or loss of grip strength. Admitted treatments in the literature are excision of the bone fragment or its open reduction and internal fixation. We report a clinical case of a high-level baseball player with hamate hook nonunion treated with an original technique of fixation using a hook plate.
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Scheufler O, Radmer S, Andresen R. Dorsal percutaneous cannulated mini-screw fixation for fractures of the hamate hook. ACTA ACUST UNITED AC 2012; 17:287-93. [PMID: 22745102 DOI: 10.1142/s0218810412970039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/13/2012] [Accepted: 01/14/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE Open fixation of acute fractures, delayed union and non-union of the hamate hook through a palmar approach has been reported. Minimal invasive fixation using a dorsal percutaneous approach and a headless cannulated mini-screw is another option not commonly considered. The authors present their case series of patients who underwent dorsal percutaneous fixation of acute fractures and delayed union of the hamate hook. METHODS This study retrospectively reviewed six consecutive patients (five male patients and one female patient) with non-displaced acute fractures (< 8 weeks) and delayed union (8 to 12 weeks) of the hamate hook treated with dorsal percutaneous cannulated mini-screw fixation. The indications for surgery included wrist pain, patient refusal of conservative treatment, and prevention of non-union and hook excision. Exclusion criteria included displacement or inadequate size of the hamate hook, previous surgery, associated carpal injury, flexor tendon rupture, and median or ulnar nerve lesion in the carpal tunnel and Guyon's canal respectively. Each fracture was visualized by radiography and computed tomography before and after the intervention. RESULTS Anatomically correct fixation of the hamate hook with central screw positioning was achieved in all patients. No displacement or disruption of the cortical shell of the hook was observed. The union rate was 100% with all patients being able to resume their pre-injury activities after an average of seven weeks from surgery. CONCLUSIONS This pilot study demonstrates that non-displaced acute fractures and delayed union of the hamate hook can be treated successfully by dorsal percutaneous cannulated mini-screw fixation with minimal morbidity and complications.
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Abstract
Osseous injuries to the ulnar aspect of the carpus are increasing in frequency because of greater participation in sporting activities. Hamate body fractures are subdivided into coronal, sagittal oblique, proximal pole, and medial tuberosity fractures. Successful treatment of coronal fractures requires identification and treatment of associated disruption or instability of the ulnar 2 carpometacarpal joints. Displaced hamate hook fractures are optimally treated with early excision to avoid sequelae such as flexor tendon and nerve injury, and to allow early return to activity. Undisplaced pisiform fractures are managed nonoperatively, whereas displaced fractures and nonunions are treated by simple excision.
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Rhee PC, Novais EN, Shives TC, Shin AY. Chondroblastoma with secondary aneurysmal bone cyst of the hamate: case report. J Hand Surg Am 2012; 37:538-42. [PMID: 22284749 DOI: 10.1016/j.jhsa.2011.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/11/2011] [Accepted: 11/13/2011] [Indexed: 02/02/2023]
Abstract
Chondroblastoma of the carpals is rare, can mimic other benign bone tumors, and presents a diagnostic challenge. There have been few cases of benign tumors involving the hamate, with only one reported case of chondroblastoma, which was treated with complete hamate excision. We present a case of chondroblastoma with secondary aneurysmal bone cyst of the hamate treated with curettage, high-speed burring, phenol, and autogenous iliac crest bone grafting. At the time of the most recent radiographic follow-up, there was full graft incorporation, preserved hamate morphology, and no evidence of recurrence.
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Affiliation(s)
- Peter C Rhee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
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Xiong G, Dai L, Zheng W, Sun Y, Tian G. Clinical classification and treatment strategy of hamate hook fracture. ACTA ACUST UNITED AC 2010; 30:762-6. [DOI: 10.1007/s11596-010-0654-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Indexed: 11/29/2022]
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35
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Nanno M, Sawaizumi T, Ito H. Simplified dorsal approach to fracture of the hamate hook with percutaneous fixation with screws. J Plast Surg Hand Surg 2010; 44:214-8. [DOI: 10.3109/02844310801956714] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.
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Affiliation(s)
- Steven Papp
- Department of Orthopaedic Surgery, University of Ottawa, Ottawa Civic Hospital, Ottawa, Ontario, Canada K1Y 4E9.
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Abstract
A wide range of hand and wrist injuries occur in today's recreational and elite athletes and account for 3% to 9% of all sports injuries. The onus is on the physician to discriminate between injuries that can be managed with an early return to sport, and those injuries that place the athlete at risk of further injury if they are not managed aggressively from the outset. The physician and the athlete must understand the balance between safe, early return to sport, and prompt surgical treatment that prevents late disability.
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Affiliation(s)
- Jeffrey Marchessault
- Department of Orthopaedic Surgery, Allegheny General Hospital, 1307 Federal Street, 2nd Floor, Pittsburgh, PA 15212, USA.
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38
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Scheufler O, Radmer S, Bogusch G, Andresen R. Minimal Invasive Fixation of Hamate Hook Fractures Through a Dorsal Percutaneous Approach Using a Mini Compression Screw: An Experimental Feasibility Study. Eur J Trauma Emerg Surg 2008; 35:397-402. [DOI: 10.1007/s00068-008-8112-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 10/02/2008] [Indexed: 10/21/2022]
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39
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Abstract
Carpal bone fractures make up a significant proportion of injuries to the wrist. The complex bone shape and articulations make diagnosis more difficult and missed injuries more common. This article reviews carpal bone fractures excluding the scaphoid.
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Affiliation(s)
- Steven Papp
- Department of Orthopaedic Surgery, University of Ottawa, Ottawa Civic Hospital, 1053 Carling Avenue, Ottawa, Ontario, Canada K1Y 4E9.
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40
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Popov N, Escaré P, Allieu Y. [Primary flexor tendon ruptures of the little finger within the carpal tunnel. Proposed classification based on six clinical cases and review of the literature]. CHIRURGIE DE LA MAIN 2007; 26:35-9. [PMID: 17418768 DOI: 10.1016/j.main.2006.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 12/08/2006] [Accepted: 12/28/2006] [Indexed: 05/14/2023]
Abstract
Six cases of primary flexor tendon rupture of the little finger within the carpal tunnel are presented. All of them were attritional ruptures caused by a rough hook of the hamate. These ruptures are rare. They have their place among the flexor tendon ruptures of the wrist and the palm. Ultrasound may by helpful to determine the level of rupture. The surgical treatment consists of excision of the hook of the hamate and tendon repair.
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Affiliation(s)
- N Popov
- Centre hospitalier de Béziers, 2, rue Valentin-Haüy, 34525 Béziers cedex, France.
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41
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Abstract
Although carpal fractures other than of the scaphoid are uncommon, vigilance in diagnosing these potentially serious fractures is paramount to early and effective treatment. Physical examination and standard plain radiographs may reveal only subtle findings. Use of special radiographic views and computed tomography may help elucidate the diagnosis. Treatment is particular to each fracture. Nondisplaced fractures should be treated nonoperatively. For intra-articular carpal bone fractures, virtually any amount of displacement is unacceptable and requires reduction and fixation. This article organizes current knowledge of these potentially difficult fractures, with a table of diagnosis and treatment guidelines.
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Affiliation(s)
- Mordechai Vigler
- Hand Surgery Service, New York University Hospital for Joint Diseases Orthopaedic Institute, Department of Orthopaedic Surgery, The New York University School of Medicine, New York, NY 10003, USA
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Scheufler O, Radmer S, Erdmann D, Germann G, Pierer G, Andresen R. Therapeutic Alternatives in Nonunion of Hamate Hook Fractures. Ann Plast Surg 2005; 55:149-54. [PMID: 16034244 DOI: 10.1097/01.sap.0000168697.05149.75] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Oliver Scheufler
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Switzerland.
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Scheufler O, Andresen R, Radmer S, Erdmann D, Exner K, Germann G. Hook of Hamate Fractures: Critical Evaluation of Different Therapeutic Procedures. Plast Reconstr Surg 2005; 115:488-97. [PMID: 15692355 DOI: 10.1097/01.prs.0000149480.25248.20] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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.
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Affiliation(s)
- Oliver Scheufler
- Department of Plastic, Reconstructive and Hand Surgery, Markus Hospital, Academic Teaching Hospital, Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
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