MANUAL MINORS
A hook of hamate fracture is an injury to the hamate bone, located on the medial side of the carpus. This fracture specifically affects the “hook” or bony prominence of the hamate and is common in athletes who use racquets, clubs, or sticks, due to direct impact or the transmission of repetitive forces through the hand. It can also occur from falls onto an outstretched hand.
Diagnosis
The diagnosis is based on:
Localised pain at the base of the ulnar side of the wrist, particularly over the hook of the hamate.
Swelling and tenderness in the wrist area, worsened when holding objects or performing gripping motions.
Reduced grip strength and possible irritation of the ulnar nerve, which passes near the hook of the hamate, leading to numbness or paraesthesia in the fourth and fifth fingers.
Standard X-rays may not clearly show the hook of hamate fracture, so specialised carpal views (oblique or semi-supinated views) or a CT scan may be required for a more accurate assessment.
Differential Diagnosis
Condition | Key Differences |
|---|---|
Triquetrum Fracture | Pain on the ulnar side of the wrist, but without specific involvement of the hook of the hamate. |
Ulnar Nerve Injury | Pain and paraesthesia in the fourth and fifth fingers, without signs of fracture on X-ray. |
Ulnar Tendinitis | Pain on the ulnar side of the wrist related to inflammation of the flexor tendons, with no evidence of bone fracture. |
Wrist Sprain | Pain without any fracture visible on imaging. |
Emergency Management
Immediate immobilisation of the wrist with a splint or cast to prevent movements that could worsen the injury.
Application of ice and administration of analgesics to control pain and reduce swelling.
Request specific X-rays and, if needed, a CT scan to confirm the hook of hamate fracture.
Avoid activities involving repetitive hand or wrist movements until a definitive diagnosis is obtained.
Definitive Treatment
Non-displaced fractures: Managed conservatively with immobilisation in a cast or splint for 6-8 weeks.
Displaced or non-union fractures: Require surgical treatment, typically involving excision of the fractured fragment or internal fixation with screws.
After treatment, physiotherapy is essential to restore wrist strength and mobility and prevent complications such as loss of function. If the fracture involves the ulnar nerve, recovery of sensation and strength in the fingers may take longer.
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