Hamate fracture
Background
- Must exclude injury to ulnar nerve/artery (hamate forms part of Guyon canal)
- May involve the body, hook, or articular surface
- Hook (common) - associated with interrupted swing of club, bat, or racquet (handle impacts hypothenar eminence)
- Body (rare) - associated with fracture-dislocations of 4th/5th metacarpals
Clinical Features
- Localized tenderness over hamate (elicited by compresing hypothenar eminence)
Differential Diagnosis
Evaluation
- Standard and carpal tunnel views should be obtained
- CT may be needed to identify occult fracture
Hamate fracture
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Hamate hook fracture
- Compression dresing or Forearm volar splint
- Nonunion is common and excision of bone may be necessary
Hamate body fracture
- Stable: Forearm volar splint immobilization
- Unstable (displaced, Guyon canal injury): splint immobilization and ortho referral
Disposition
See Also
References
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