Hamate Fracture Follow-up
- Author: Amy Powell, MD; Chief Editor: Sherwin SW Ho, MD more...
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.
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.
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.
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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). For most isolated hamate fractures treated soon after the injury, the prognosis is excellent.
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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