Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Hamate Fracture Medication

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

Medication Summary

Pain control following surgery is the most common medication concern. Usually, 5-7 days of a low-strength narcotic analgesic, followed by over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), is sufficient to control pain in most patients. Sufficient amounts of pain medication should be used in the early phases of physical therapy to allow maximum movement with minimal discomfort. Pain control encourages the patient to continue in the program and speeds recovery of the wrist.

Antibiotic coverage has proven to have little value in the full spectrum of hand injuries; however, its use in open fractures is of definite value.[26, 27] Although only a short course, 1-5 days of cephalosporin therapy must be administered. The speed of administration is of primary concern. Continued therapy more than 48 hours after definitive wound closure has been achieved is not necessary. No antibiotic therapy can compensate for a lack of adequate debridement.[28]

Next

Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma.

Related Medscape resources:

Resource CenterPain Management: Advanced Approaches to Chronic Pain Management

Resource CenterPain Management: Pharmacologic Approaches

Hydrocodone/Acetaminophen (Lortab, Vicodin, Norcet),

 

Indicated for moderate to severe pain.

Previous
Next

Nonsteroidal anti-inflammatory drugs

Class Summary

Although most NSAIDs are used primarily for their anti-inflammatory effects, they are effective analgesics and are useful for mild to moderate pain.

Related Medscape Reference topic:

Nonsteroidal Anti-inflammatory Agent Toxicity

Ibuprofen (Motrin, Ibuprin)

 

DOC for mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Previous
Next

Antibiotics

Class Summary

Antibiotic therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

Related Medscape resource:

Resource CenterSepsis: Pathophysiology and Treatment

Cefazolin sodium (Ancef, Kefzol, Zolicef)

 

First-generation cephalosporin. Bactericidal, binds to bacterial membranes, and inhibits cell wall synthesis. Has a half-life of 1.4-1.8 h, which is increased in the presence of renal dysfunction. Excreted primarily unchanged in urine.

Previous
 
 
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.

References
  1. Lister G. The Hand: Diagnosis and Indications. 3rd ed. Philadelphia, Pa: Churchill Livingstone; 1993. 88-92.

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

  3. Goliver JA, Adamow JS, Goliver J. Hamate body and capitate fracture in punch injury. Am J Emerg Med. 2014 Oct. 32 (10):1303.e1-2. [Medline].

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

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

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

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

  8. Bishop AT, Beckenbaugh RD. Fracture of the hamate hook. J Hand Surg [Am]. 1988 Jan. 13(1):135-9. [Medline].

  9. Welling RD, Jacobson JA, Jamadar DA, et al. MDCT and radiography of wrist fractures: radiographic sensitivity and fracture patterns. AJR Am J Roentgenol. 2008 Jan. 190(1):10-6. [Medline].

  10. Andresen R, Radmer S, Sparmann M, Bogusch G, Banzer D. Imaging of hamate bone fractures in conventional X-rays and high-resolution computed tomography. An in vitro study. Invest Radiol. 1999 Jan. 34(1):46-50. [Medline].

  11. Scheufler O, Andresen R, Radmer S, et al. Hook of hamate fractures: critical evaluation of different therapeutic procedures. Plast Reconstr Surg. 2005 Feb. 115(2):488-97. [Medline].

  12. Tolat AR, Humphrey JA, McGovern PD, Compson J. Surgical excision of ununited hook of hamate fractures via the carpal tunnel approach. Injury. 2014 Oct. 45 (10):1554-6. [Medline].

  13. Valente L, Sousa A, Gonçalves AM, Loureiro M, Almeida L. [Fracture of the hamate with carpometacarpal dislocation] [Portugese, English]. Acta Med Port. 2007 Mar-Apr. 20(2):179-84. [Medline]. [Full Text].

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

  15. 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].

  16. Pajares-López M, Hernández-Cortés P, Robles-Molina MJ. Rupture of small finger flexor tendons secondary to asymptomatic nonunion of the hamate hook. Orthopedics. 2011 Jan 1. 34(2):142. [Medline].

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

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

  19. Nanno M, Sawaizumi T, Ito H. Simplified dorsal approach to fracture of the hamate hook with percutaneous fixation with screws. J Plast Surg Hand Surg. 2010 Nov. 44(4-5):214-8. [Medline].

  20. Cano Gala C, Pescador Hernández D, Rendón Díaz DA, López Olmedo J, Blanco Blanco J. Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: A case report and review of literature of the last 20 years. Int J Surg Case Rep. 2013. 4(5):442-5. [Medline].

  21. Gill NW, Rendeiro DG. Hook of the hamate fracture. J Orthop Sports Phys Ther. 2010 May. 40(5):325. [Medline].

  22. Fujioka H, Tsunoda M, Noda M, Matsui N, Mizuno K. Treatment of ununited fracture of the hook of hamate by low-intensity pulsed ultrasound: a case report. J Hand Surg [Am]. 2000 Jan. 25(1):77-9. [Medline].

  23. Sakuma Y, Iwamoto T, Momohara S. Ununited fracture of the hook of hamate treated with low-intensity pulsed ultrasound in an older middle-aged patient. Clin J Sport Med. 2014 Jul. 24 (4):358-9. [Medline].

  24. Tomaru M, Osada D, Fujita S, Tamai K. Treatment of hook of the hamate fractures in adults using low-intensity pulsed ultrasound. Hand Surg. 2014. 19 (3):433-6. [Medline].

  25. Devers BN, Douglas KC, Naik RD, Lee DH, Watson JT, Weikert DR. Outcomes of hook of hamate fracture excision in high-level amateur athletes. J Hand Surg Am. 2013 Jan. 38(1):72-6. [Medline].

  26. 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]. 1988 Nov. 13(6):960-4. [Medline].

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

  28. Freeland AE, Jabaley ME. Stabilization of fractures in the hand and wrist with traumatic soft tissue and bone loss. Hand Clin. 1988 Aug. 4(3):425-36. [Medline].

  29. 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. 2005 Aug. 55(2):149-54. [Medline].

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

  31. 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].

  32. Failla JM, Amadio PC. Recognition and treatment of uncommon carpal fractures. Hand Clin. 1988 Aug. 4(3):469-76. [Medline].

Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.