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Hamate Fracture Follow-up

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

Return to Play

Return to full activity depends on the patient's activity level and desires. Return to full activity is also dependent on the initial fracture treatment (see Physical Therapy). Typically, if treated conservatively, simple fractures of the hamate are unified within 6-8 weeks of injury.

Patient participation in full-contact sports, such as football, usually requires bracing or protection for the wrist until full musculature and flexibility have returned. This improvement should be achieved within 12 weeks with a diligent physical therapy program. In contrast, if the injury is treated surgically with either ORIF or excision, return to play occurs much sooner. Although no evidence-based guidelines have been developed, the general consensus is that return to play takes 6-8 weeks after either surgery, but this is very individualized and often depends on the level of the athlete.

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Complications

The most frequent complication is nonunion.[4, 29, 30] This can follow conservative treatment in more than 50% of patients. Often, these patients present with continued palmar pain, especially with grip. Conventional radiographs can miss this diagnosis in 30-50% of patients. Therefore if the clinical suspicion is high and radiographic findings are negative, CT scanning should be performed. The treatment of nonunion involves either excision of the hamate hook or ORIF (see Surgical Intervention).

In cases in which internal fixation has been tried and has failed, excision of the fragment is the recommended treatment. These fragments may be small, and full range of motion is often preserved. Pathologic fractures due to cyst formation in the hamate may also occur. These types of fractures are treated best with bone packing, using tissue from the iliac crest, and external fixation. In addition, there has been one case report that described avascular necrosis occurring in the hamate hook.[30]

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Prevention

Having good strength and flexibility of both the wrist flexors and extensors can aid in the prevention of some wrist injuries. If participating in sports activities in which diving or falling is not an uncommon occurrence (eg, rollerblading, skiing, ice skating), a protective wrist guard may be recommended to prevent injury to the wrist and hand. Athletes who golf may have increased risk for fracturing the hook of the hamate secondary to repetitive wrist extension. One good method of prevention in this population is to ensure that a proper length of club is always used.

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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Prognosis

The prognosis of hamate fractures depends on the degree of injury encountered and the patient's effort in the physical therapy program. In a retrospective review of 29 cases, the patient's functional recovery was indirectly related to the degree of soft-tissue damage at the time of the injury (an increase in soft-tissue damage results in a decrease in functional recovery).[5] For most isolated hamate fractures treated soon after the injury, the prognosis is excellent.

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Education

Patient education is an important part of the rehabilitation program for patients recovering from hamate fractures. Patients need to have a good understanding of the healing process and must adhere to recommendations provided by their physician and physical therapist to recover full strength and functional abilities.

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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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