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Hamate Fracture Clinical Presentation

  • Author: Amy Powell, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Oct 13, 2015
 

History

Hamate hook fractures are usually seen in individuals who participate in sports involving a racquet, bat, or club or in individuals who have a history of falling on an outstretched hand.[1, 2, 5, 6, 7, 8] Because most patients with this injury seek medical advice only after persistent symptoms, they often present weeks to months after the initial injury. Most report palmar pain aggravated by grasp, pain with dorsoulnar deviation, and pain with flexion of the fourth and fifth digits.

In the case of a hamate body fracture or direct trauma, persons may present immediately. Fractures involving the body of the hamate are typically associated with high-energy, direct-force trauma or crushing injuries. External evidence of these forces is evident in these individuals.

Related Medscape Reference topics:

Carpal Fractures

Wrist Fracture in Emergency Medicine

Wrist Fractures and Dislocations

Metacarpal Fractures

Related Medscape resources:

Resource Center Exercise and Sports Medicine

Resource Center Fracture

Resource Center Trauma

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Physical

Physical examination findings are usually nonspecific and may even be absent. If symptoms are present, physical examination typically reveals discrete point tenderness with palpation over the hook of the hamate, diminished grip strength, and, secondary to the proximity of hamate fractures to the ulnar nerve, paresthesia may be present in the fourth and fifth fingers.

Resisted distal interphalangeal flexion of the fourth and fifth fingers with the wrist in ulnar deviation causes pain over the fractured hook, whereas testing in radial deviation does not. In the case of more severe injury, brief examination for neurologic and vascular competency, accompanied by basic radiographs, are all that is appropriate in an emergency department setting. More detailed exploration and radiographic studies should be performed later, while the patient is under anesthesia.

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Causes

Hamate fractures are generally associated with sports activities that use a racquet, bat, or club. For a more complete discussion of the causes and mechanisms of hamate fractures, see Sport-Specific Biomechanics.

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Contributor Information and Disclosures
Author

Amy Powell, MD Assistant Clinical Professor, Department of Orthopedics, University of Utah

Amy Powell, MD is a member of the following medical societies: American College of Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Janos P Ertl, MD Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Chief, Sports Medicine and Arthroscopy, Indiana University School of Medicine

Janos P Ertl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Hungarian Medical Association of America, Sierra Sacramento Valley Medical Society

Disclosure: Nothing to disclose.

Nancy J Taubenheim, DPT Staff Physical Therapist, Clinical Instructor, Department of Rehabilitation Services, Bryan LGH Medical Center

Disclosure: Nothing to disclose.

Warren S Theis, MD Staff Physician, Department of General Surgery, Carilion Roanoke Memorial Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

Acknowledgements

Emily Harold, MD Staff Physician, Department of Internal Medicine, University of Utah Hospital

Disclosure: Nothing to disclose.

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Posterior (dorsal) view of the wrist.
Anterior palmar view.
Anteroposterior view of the wrist.
Lateral view of the wrist.
Oblique view of the wrist.
Computed tomography scan of the wrist.
Lateral computed tomography scan of the wrist.
Reconstruction of the hamate fracture.
 
 
 
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