Fracture of the Hook of the Hamate

Hamate is one of the eight bones in the wrist. It has a bony extension on the palm side called “the hook”. The hook of the hamate forms the sidewall of the carpal tunnel. The roof of the carpal tunnel is a thick ligament, transverse carpal ligament that attaches on the hook of the hamate. One can feel the hook of the hamate in the pillar area (the heel of the palm) on the small finger side.

Fracture of the hook of the hamate is an uncommon condition. It often occurs with sports activities such as tennis, golf and baseball. It may go undiagnosed and can be the cause of long standing wrist pain. The blow of the bat or the racquet on the bone may cause a direct injury. With indirect injury, the force on the transverse carpal ligament wrenches the hook. The hamate breaks at its weakest point where the hook connects to the body. The blood vessel to the hook can be injured as well, causing disruption to the blood supply. The loss of blood supply can result in necrosis, -death and softening, of the bone. The loss of blood supply to the hook is the biggest challenge to fracture healing and may cause nonunion.

These fractures are better treated early and surgically if there is any displacement. Surgical treatment is better than cast treatment in these cases. Worried about the blood supply to the hamate, some surgeons will recommend removing the broken part. Others believe fixation of the fracture restores the anatomy and should be the choice in athletes. Both methods have satisfactory and comparable outcomes.

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