eMedicine Specialties > Sports Medicine > Wrist and Hand

Hamate Fracture: Follow-up

Author: Amy Powell, MD, Assistant Clinical Professor, Department of Orthopedics, University of Utah
Coauthor(s): Emily Harold, MD, Staff Physician, Department of Internal Medicine, University of Utah Hospital; Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital; Warren S Theis, MD, Staff Physician, Department of General Surgery, Carilion Roanoke Memorial Hospital; Nancy J Taubenheim, DPT, Staff Physical Therapist, Clinical Instructor, Department of Rehabilitation Services, Bryan LGH Medical Center
Contributor Information and Disclosures

Updated: May 13, 2008

Follow-up

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.

Complications

The most frequent complication is nonunion.3,20,21 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.21

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 eMedicine topics:
Carpal Fractures
Fracture, Wrist
Hand, Fractures and Dislocations: Wrist
Metacarpal Fractures

Related Medscape topics:
Resource Center Exercise and Sports Medicine
Resource Center Fracture
Resource Center Trauma

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).4 For most isolated hamate fractures treated soon after the injury, the prognosis is excellent.

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.

 


More on Hamate Fracture

Overview: Hamate Fracture
Differential Diagnoses & Workup: Hamate Fracture
Treatment & Medication: Hamate Fracture
Follow-up: Hamate Fracture
Multimedia: Hamate Fracture
References
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References

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  2. Dobyns JH, Linscheid RL, Cooney WP 3rd. Fractures and dislocations on the wrist. In: Rockwood CA, Green DP, eds. Fractures in Adults. Vol 1. Philadelphia, Pa: JB Lippincott; 1984:411-51.

  3. Failla JM. Hook of hamate vascularity: vulnerability to osteonecrosis and nonunion. J Hand Surg [Am]. Nov 1993;18(6):1075-9. [Medline].

  4. Hirano K, Inoue G. Classification and treatment of hamate fractures. Hand Surg. 2005;10(2-3):151-7. [Medline].

  5. Guha AR, Marynissen H. Stress fracture of the hook of the hamate. Br J Sports Med. Jun 2002;36(3):224-5. [Medline]. [Full Text].

  6. Boulas HJ, Milek MA. Hook of the hamate fractures. Diagnosis, treatment, and complications. Orthop Rev. Jun 1990;19(6):518-29. [Medline].

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  12. Marck KW, Klasen HJ. Fracture-dislocation of the hamatometacarpal joint: a case report. J Hand Surg [Am]. Jan 1986;11(1):128-30. [Medline].

  13. Kapickis M, Looi KP, Khin-Sze Chong A. Combined fractures of the body and hook of hamate: a form of ulnar axial injury of the wrist. Scand J Plast Reconstr Surg Hand Surg. 2005;39(2):116-9. [Medline].

  14. Gillespy T 3rd, Stork JJ, Dell PC. Dorsal fracture of the hamate: distinctive radiographic appearance. AJR Am J Roentgenol. Aug 1988;151(2):351-3. [Medline]. [Full Text].

  15. Freeland AE, Finley JS. Displaced dorsal oblique fracture of the hamate treated with a cortical mini lag screw. J Hand Surg [Am]. Sep 1986;11(5):656-8. [Medline].

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  17. Peacock KC, Hanna DP, Kirkpatrick K, et al. Efficacy of perioperative cefamandole with postoperative cephalexin in the primary outpatient treatment of open wounds of the hand. J Hand Surg [Am]. Nov 1988;13(6):960-4. [Medline].

  18. Antrum RM, Solomkin JS. A review of antibiotic prophylaxis for open fractures. Orthop Rev. Apr 1987;16(4):246-54. [Medline].

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  20. Scheufler O, Radmer S, Erdmann D, et al. Therapeutic alternatives in nonunion of hamate hook fractures: personal experience in 8 patients and review of literature. Ann Plast Surg. Aug 2005;55(2):149-54. [Medline].

  21. Failla JM. Osteonecrosis associated with nonunion of the hook of the hamate. Orthopedics. Feb 1993;16(2):217-8. [Medline].

  22. Dahlin LB, Ljungberg E, Esserlind AL. Injuries of the hand and forearm in young children caused by steam roller presses in laundries. Scand J Plast Reconstr Surg Hand Surg. 2008;42(1):43-7. [Medline].

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Further Reading

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Keywords

fracture of the hook, hook fracture, fracture of the hamate, hook of hamate fracture, fracture of the hook of hamate, wrist fracture, wrist trauma, hamate trauma, broken wrist, wrist injury

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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, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Emily Harold, MD, Staff Physician, Department of Internal Medicine, University of Utah Hospital
Disclosure: Nothing to disclose.

Janos P Ertl, MD, Assistant Professor, Department of Orthopedic Surgery, Indiana University School of Medicine; Chief of Orthopedic Surgery, Wishard Hospital
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, and Sierra Sacramento Valley Medical Society
Disclosure: Nothing to disclose.

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

Medical Editor

Gerard A Malanga, MD, Director of Pain Management, Overlook Hospital; Director of PM&R Sports Medicine Fellowship, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, UMDNJ-New Jersey Medical School; Clinical Chief, Rehabilitation Medicine and Electrodiagnosis, St Michael's Medical Center; Fellow, American College of Sports Medicine
Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, North American Spine Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Cephalon Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Henry T Goitz, MD, Fellowship Director, Sports Medicine, Department of Orthopedic Surgery, Henry Ford Hospital
Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
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
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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