Diagnosis and Management of Hook of Hamate Fractures
Assaf Kadar, MD1; Marissa Suchyta, BA2; Allen T. Bishop, MD3; Steven L Moran, MD4; Diya Mohammed Sabbagh, MD2; (1)Orthopedic Division, Tel Aviv Sourasky Medical Center Orthopaedic Division, Tel Aviv, Israel, (2)Mayo Clinic, Rochester, MN, (3)Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester, MN, (4)Division of Plastic Surgery, Mayo Clinic, Rochester, MN
Purpose Hook of hamate fracture is a rare injury occurring predominantly in batting sports. This injury is reported to be easily misdiagnosed, with delays in treatment leading to increasing rates of non-union. The purpose of this study is to evaluate the average time to diagnosis of this injury in an era of advanced imaging, and evaluate patient reported outcomes for operative and non-operative treatment for these fractures
Methods A retrospective study was performed on 51 patients treated for hook of hamate fractures. Medical records and radiographs were reviewed. The quick Disabilities of the Arm, Shoulder and Hand (quickDASH), Visual analog scale score and satisfaction of treatment questionnaire were sent to patients. Response rate was 70.5%. A comparison between operative (14 patients) and non-operative (37 patients) treatment groups was carried out on pain, grip, hand functionality and complications. Mean follow up time was 72.8 months.
Results Hook of hamate fractures were usually diagnosed with advanced imaging in a median time of 27 days. Carpal tunnel view radiographs had detection rate of 43%. Classical clinical finding of hook of hamate tenderness and pain with flexion of ring and small finger were positive in 80% and 72.2% of patients, respectively. Non-union occurred in 24% of patients with non-operative treatment despite early diagnosis and treatment. This complication did not occur in the operative group. Both treatment groups achieved good clinical results with grip strength 80.9% of that of the non-injured hand and a median DASH score of 2.3. 93.3% of patients who had surgery said they would do it again.
Conclusion Advanced imaging improved the time from injury to diagnosis and treatment compared to historical large case series. Non-union is common in patients treated non-operatively despite early diagnosis and treatment; however these patients can be later treated with hook excision with excellent clinical results.
Figure. Axial CT of wrist demonstrating hook of hamate fracture following a golf injury (A). Follow up CT eight months after open reduction internal fixation shows complete fracture union (B).
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