Hamate Fracture Clinical Presentation

Updated: Aug 06, 2018
  • Author: Amy Powell, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Presentation

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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