The hamate hook is supplied by two blood vessels, one entering from the ulnar tip, while the other enters through the radial base [12]. The hamate has a prominent process that projects anteriorly. The hook-like process is called hamulus. Hook of hamate fractures (also sometimes termed type 1 hamate fractures) are rare. Always obtain “tunnel view” or carpal tunnel view if there is a concern for a hook of hamate fracture. The calcification of the unciform bone is seen on X-rays during puberty and is sometimes used in orthodontics to determine if an adolescent patient is suitable for orthognathic intervention (i.e. There will be acute tenderness on palpation in the anatomical snuff box. Hook of Hamate Fracture: A fracture of one of the eight carpal bones located on the ulnar side of the distal carpal row. The hook of hamate (Latin: hamulus) is found at the proximal, ulnar side of the hamate bone.The hook is a curved, hook-like process that projects 1–2 mm distally and radially. Fractures of the carpal hamate are rare injuries. Hamate bone of the left hand. Cross section of wrist (thumb on left). Left hand anterior view (palmar view). It is situated in the distal row of carpal bones on the medial side of the wrist. The hamate is an irregularly shaped carpal bone found within the hand. Clinical findings of hook of hamate tenderness had better sensitivity than carpal tunnel-view radiographs. Heck, I’ll throw in both nuts. The ossification of the hamate starts between 1 and 12 months. A 24-year-old professional baseball outfielder reports persistent pain in the hypothenar region when batting for the past year. Digit. [4][5][6][7][8] This condition has been called "Wilson's Wrist".[9]. The hamate bone is one of eight carpal bones, it is a triangular bone, composed of a body and a hook, located on the ulnar side of the distal carpal row. Tested Concept, (SBQ07SM.40) An x-ray is needed in order to accurately diagnose a fracture of the Hook of the hamate. Its medial surface to the flexor digiti minimi brevis and opponens digiti minimi; its lateral side is grooved for the passage of the flexor tendons into the palm of the hand. Both treatment groups achieved good clinical results, with a grip strength of 80% compared … J Hand Surg Am 1989; 14:486. The Hook of Hamate fractures are almost exclusively a golfing injury, and injury to the distal end of the ulna nerve are not uncommon. The hook of the hamate pull test (15) (HPPT) is a clinical test for diagnosing a hook of hamate fracture, which was negative in this case. Patients present with acute onset of pain localised over the ulnar aspect of the wrist and reduction in grip strength. The hook of the hamate pull test (15) (HPPT) is a clinical test for diagnosing a hook of hamate fracture, which was negative in this case. Expansions 2-5 Median C8,T I Flex Digit at MCP, Extend IP joints Lumbricals J & 4 Med. It bears an uncinate (unciform) hamulus (hook of hamate) which projects in a volar fashion from the distal part of its palmar surface. The case shows a carpal tunnel view for the diagnosis of the hook of hamate fracture. We studied the clinical and radiological findings in 12 patients who had fracture of the hook of the hamate. Hook of hamate fractures are further subdivided according to their location in the hook: Type 1 fractures are located at the distal hook, type 2 at the middle, and type 3 are located at the base of the hook. It bears an uncinate (unciform) hamulus (hook of hamate) which projects in a volar fashion from the distal part of its palmar surface. Isolated transverse fracture of the body of the hamate … We hypothesize that there are variations in the hook of the hamate in the general population. The hook is located by projecting a line from the pisiform to the center of the head of the index metacarpal. The hook of hamate forms the ulnar border of the carpal canal. The first is the inner (medial) border of the carpal tunnel, through which the median nerve runs. In each case, the initial injury was considered trivial; medical attention was not sought until rupture of the little profundus/superficialis tendon occurred. B, Oblique view. These eight bones are stacked neatly in two rows at the base of the hand (directly under the thicker parts of the palm). Closed rupture of the flexor tendons to the small finger, excision of large hook of hamate fractures, Lunate Dislocation (Perilunate dissociation), Gymnast's Wrist (Distal Radial Physeal Stress Syndrome), Scaphoid Nonunion Advanced Collapse (SNAC), Carpal Instability Nondissociative (CIND), Constrictive Ring Syndrome (Streeter's Dysplasia), Thromboangiitis Obliterans (Buerger's disease), hook of hamate fractures are rare, often missed, injuries generally as a result of a direct blow to the hamate bone most commonly seen in athletes, treatment is generally patient-specific and depends on chronicity of injury, carpal bone that is distal and radial to the pisiform, roof - superficial palmar carpal ligament, floor - deep flexor retinaculum, hypothenar muscles, ulnar border - pisiform and pisohamate ligament, one of the palpable attachments of the flexor retinaculum, vessels enter the hamate base via a radial and ulnar foramina to supply the hook of the hamate, ulnar vessel is absent in 29% of patients, absent ulnar vessel considered the reason for high non-union rate of hook of hamate fractures, positive tinel's over Guyon's canal may be present, hand held in ulnar deviation as patient flexes DIP joints of the ulnar 2 digits against resistance, the flexor tendons act as a deforming force on the fracture site, positive test elicits pain, establish diagnosis if radiographs are negative, most accurate method of diagnosis in cases of high-clinical suspicion, majority of nondisplaced acute hook of hamate fractures, majority of patients are pain-free and have full ROM despite non-union, modified volar wrist incision in lined with the ulnar border of ring finger, release of the guyon canal generally also performed, hook should be removed subperiosteally to avoid damage to motor branch of ulnar nerve, considered natural course of fracture given fracture site motion and poor blood supply. Hamate shown in yellow. Transverse section across the wrist and digits. I am not a golfer, but I too had hamate hook surgery. It has a hook-like projection on its surface (thus its name) that can be fractured in certain activities. It has a hook-like projection on its surface (thus its name) that can be fractured in certain activities. golf, baseball, racquet sports) from a direct blow while swinging. Bones of the left hand. Because the hook of the hamate bone is directly deep to the ulnar nerve and artery, direct impact on the ulnar aspect of the hand can cause injury to the ulnar nerve and artery. often seen in athletes in sports requiring gripping, small finger/ring finger flexor tendonitis or tendon rupture, deep branch of ulnar nerve lies under the hook, average of 4 weeks from injury to diagnosis, best radiograph to see hook of hamate fracture, can be missed if nondisplaced and if CT cuts greater than 1 mm, symptomatic chronic hook of hamate fractures with non-union, hook of hamate fractures with ulnar neuritis, fastest recovery and return to play noted for athletes who wish for prompt return to play, some studies show decreased small finger FDP tendon strength by 10-15% with excision, excision leads to 5 mm of ulnar displacement of small finger FDP tendon, acute and significantly displaced fractures in patient's unable to tolerate reduction in grip strength, small case series have shown nearly 100% union rate, theoretically improved grip strength compared to excision, small-fragment headless compression or countersunk screws, screws need to be countersunk to prevent irritation of the deep motor branch of the ulnar nerve. This is the first described case of isolated hamate dislocation presenting with symptoms and examination consistent with acute compartment syndrome of the hand. They occur from the hamate fracturing after blunt trauma, falls, and in sports player (e.g. METHODS: One thousand pairs of hamates (2,000 hamates) from the Hamann-Todd Collection at the Cleveland Natural History Museum were analyzed. They can be confusing to diagnose and treat due to the complexity of their structure. The hamate bone is sometimes described as triangular in shape and others describe it as more square-like. Dr. Knight removes the hook of hamate after a college baseball player sustained a fracture to the hook. Hamate fracture - Oblique view. The hamate has a wedge-shaped body. All were treated with excision of the hook and tendon repair, which usua … Hook of the hamate fractures. Each arm was then mounted in a jig designed to hold and stabilize the arm and hand in supination. The hamate bone is a wedge-shaped carpal bone on the pinky finger side, of the wrist. Ulnar tunnel decompression with hook of hamate excision provides good … A 24-year-old racquetball player presents after accidentally striking his racket against the wall during a match three months ago.
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