 25 yo male, Double-A

shortstop from out of town
presents to ED c/o acute
onset left wrist pain,
occurring after fouling...
Xray hand

CT wrist
H

Carpal tunnel

hook

1. Hand xray appears nml – AP view frequently is nondiagnostic with Hamate
fractures (esp hook fx)...
 Treatment is similar to most other carpal fractures:
 1. Pain control
 2. Splint immobilization with short arm, volar ...
 Hook fx more common than body
 Associated with swinging injuries
 Baseball bat, golf club, racquet
 Due to vibration ...
Hamate fx of body with
associated intra-articular,
proximal 4th MC fx.

Normal Carpal Tunnel (reverse
oblique) view.
 http://www.biomedsearch.com/nih/Case-report




right-hamate-hook/17038179.html
Marx: Rosen’s Emergency Medicine, 7t...
Hamate Fracture
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Hamate Fracture

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Hamate Fracture

  1. 1.  25 yo male, Double-A shortstop from out of town presents to ED c/o acute onset left wrist pain, occurring after fouling off a pitch, during an at bat earlier that day. Additionally c/o numbness to 5th digit of left hand. Pt throws right, bats right.  AFVSS  Gen: WDWN, NAD  MSK: Left hand shows pain 2/2 axial loading to 4th and 5th metacarpals, moderate TTP over hypothenar eminance,  sensation to 5th digit and lateral aspect of 4th, and decreased grip strength. ROM to wrist and hand is nml.
  2. 2. Xray hand CT wrist
  3. 3. H Carpal tunnel hook 1. Hand xray appears nml – AP view frequently is nondiagnostic with Hamate fractures (esp hook fx). Diffinitively dx with carpal tunnel view radiograph if suspicion is high. 2. CT will most easily demonstrate fracture, but not necessary for diagnosis (100% sensitive-Rosen’s***).
  4. 4.  Treatment is similar to most other carpal fractures:  1. Pain control  2. Splint immobilization with short arm, volar splint  3. Orthopedic referral in 1-2 weeks.  Hook fractures can cause ulnar nerve injury or progress to non-union, both will need outpatient hook excision.
  5. 5.  Hook fx more common than body  Associated with swinging injuries  Baseball bat, golf club, racquet  Due to vibration or direct blow to hamate  Hook form border of Guyon’s Canal, housing Ulnar artery and nerve  Dx usually confirmed by point TTP over hook – 1 cm distal and radial to pisiform  Also, decreased grip strength, dorsal wrist pain, ulnar paresthesias  Assoc with fracture/dislocation at base of 4th or 5th MCs  Tx key is early immobilization to prevent avascular complications, however most will need hook excision with excellent prognosis and favorable return to baseline function
  6. 6. Hamate fx of body with associated intra-articular, proximal 4th MC fx. Normal Carpal Tunnel (reverse oblique) view.
  7. 7.  http://www.biomedsearch.com/nih/Case-report    right-hamate-hook/17038179.html Marx: Rosen’s Emergency Medicine, 7th ed. Ch 48: Wrist and Forearm http://www.springerimages.com/Images/RSS/110.1007_s00256-009-0842-3-0 Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7th ed. Chapter 226: Wrist Injuries http://www.wheelessonline.com/ortho/hamate
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