Question

https://prod-images-static.radiopaedia.org/images/52314030/8089eeb717fd6d20e108ec2e586ba4.jpg

Answer

Hamate Fractures:

Rare (2 to 4% of all carpal fractures)

Mechanism:  Usually a direct blow from a stick sport (bat, club or racket)

• https://upload.orthobullets.com/topic/6035/images/hamate_baseball.jpg

Have increased suspicion in these athletes who present w/ ulnar sided wrist pain

Presents with hypothenar pain and pain with gripping activities

• https://upload.orthobullets.com/topic/6035/images/hamate_golf.jpg

Fractures occur in two locations: the body and the hook of the hamate

• The hook functions as a pulley for the flexor tendons of the ring and small fingers.
• Fx of the body are more common than fx of the hook

On exam you will find:

• Most patients complain of pain and tenderness on ulnar side of palm (localized over the hamate ) or on the dorsoulnar aspect of the wrist

Hook of Hamate Pull Test

Examiner places the wrist in full ulnar deviation with the fingers flexed.

Examiner pulls on the ring and pinky finger with the patient resisting the pull.

Positive test

• Pain in area of the hook of hamate +/- radiating through palm.
• https://wikism.org/w/images/thumb/e/ec/Hook_of_hamate_fracture_test.jpg/450px-Hook_of_hamate_fracture_test.jpg

Diagnosis:

• PA and lateral views of the wrist may show a body fracture but will frequently MISS a fracture of the hook of the hamate. 
• Most fractures can be diagnosed by plain films in the "Carpal tunnel view"
• CT scan can also be used to see the fracture