Dr Pr. D’Agostino, MD, PhD

Hand Clinic Brussels - Lasne

LOUISE +32 2 534 29 99 LASNE +32 2 653 11 11

Hamate fracture

QT Pathologies (EN)

The hamate is one of the small bones of the wrist. The hook (hamulus) is the particular part of that bone that protrudes toward your palm, and is vulnerable to injury.

  • Anatomy of the carpal bones: the hamate bone belongs to the second row Anatomy of the carpal bones: the hamate bone belongs to the second row Anatomy images courtesy and copyright of Primal Pictures Ltd – www.primalpictures.com

Two Identified mechanisms are implicated in the occurrence of such a fracture:

  • The first mechanism is of direct type by repeated shock on the basis of the hamulus. This mechanism is unique to sports requiring a grip with direct support on the basis of the hypothenar eminence, of a handful or a handle such as racquet sports, golf, baseball, hockey, mountain biking, ... The shock wave is reflected at the palmar side of the wrist through it. In playing golf, the non-dominant side is affected preferentially while in tennis or squash, the dominant side which will be affected.
  • The second mechanism is meanwhile of indirect type and analysis is more complex. It involves a set of traction with ligament affect the hamulus secondary to a fall in wrist extension.

 

The patient describes pain in the palm of the hand, with or without swelling sitting on the ulnar (little finger) side of the wrist, aggravated by gripping.

If it irritates the adjacent ulnar nerve, it may cause numbness and tingling in the ring and little fingers.

The tendons that bend the ring and little fingers are also adjacent to the hook, and movement of these fingers may be painful and give a sensation of “catching” or “clicking” if these tendons are rubbing on the fractured bone. Left untreated, the tendons can even gradually fray and rupture.

The diagnosis is suggested by the mechanism of injury, initial signs and symptoms, but only confirmed by the radiological assessment.

The fracture is often difficult to see on plain X-rays because of the overlap of the other small bones in the wrist. A CT scan is often used to visualize the area of the hamate hook in greater detail when a fracture is suspected.

  • Fracture of the hook (hamulus) of the hamate (hamate) Fracture of the hook (hamulus) of the hamate (hamate)

Treatment may consist of splinting or casting if the fracture is seen very early after injury.

If displaced or seen late with continued pain, numbness and tingling, or tendon irritation, surgery is usually performed to remove the broken bone fragment.

During your consultation, Dr. D'Agostino will discuss the current treatment options and can help you choose the best treatment based on your particular case.