March 1st, 2019 , Orthopedics

Excision of Incomplete Hook of the Hamate Fractures

Authors: Barber JA, Loeffler B, Gaston RG, Lourie GM


Incomplete hook of the hamate fractures are difficult to diagnose and should be promptly removed to expedite return to sport. From January 2000 to November 2016, 143 excisions of the hook of the hamate were performed following fracture of the hamulus. Of these 143 excisions, 17 were performed because of a preoperative diagnosis of incomplete fracture. The inclusion criteria for diagnosis were as follows: (1) history of ulnar-sided wrist pain; (2) positive result on hook of the hamate pull test on physical examination; and (3) evidence on computed tomography or magnetic resonance imaging of an incomplete fracture of the hook of the hamate. Time to diagnosis and treatment, return to sport, postoperative complications, preoperative treatment, and effectiveness were recorded. Seventeen diagnoses of partially united hook of the hamate fractures had been made since January 2000. All of these patients underwent excision of the hamulus. The mean time to diagnosis was 11.1 weeks. The mean delay in surgical treatment was 6.2 weeks. All 17 patients were able to return to sport at a mean of 6.8 weeks. Patients initially seen by 1 of the senior authors had a 7.9-week earlier return to sport. Eight patients received preoperative treatment. Preoperative treatment failed for all 8, and they underwent subsequent hamulus excision. The diagnosis of an incomplete hook of the hamate fracture is difficult and often delayed. These fractures should be managed with early excision, as they do well with early return to sport and are prone to fail nonoperative treatment. Delay in diagnosis and treatment prolongs return to sport.

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