Fractures of the Hamate and Pisiform Bones
Introduction
As a result of greater participation in sporting activities, osseous injuries to the ulnar aspect of the carpus are becoming more prevalent.1, 2 Hamatametacarpal injuries encompass a broad but complex subgroup of injuries, most commonly sustained when the clenched fist strikes an unyielding object.3 Fractures of the pisiform, hamate hook, and body arise principally during stick handling sports such as golf, tennis, or baseball. Often without a clear history of a traumatic event, these injuries are frequently misdiagnosed.4, 5 Physical findings such as diminished grip strength, ulnar nerve paresthesias, or mild carpal tunnel syndrome are often mild and nonspecific. Plain radiographs may show subtle features or may be nondiagnostic. Neglect of osseous injuries to the ulnar carpus affects the ability to hold a racquet or bat and weakens the grip. To make a timely diagnosis and institute appropriate treatment, a high index of clinical suspicion and a low threshold for proceeding to advanced imaging is required.
Section snippets
Fractures of the hamate bone
In 1934, Milch6 identified 2 main types of hamate fracture: fractures of the body and fractures of the hook. The primary line in body fractures was noted to pass either medial or, more commonly, lateral to the hook obliquely in direction from dorsomedial to palmar-lateral. Because of the presence of strong intercarpal ligaments, Milch6 remarked that displacement was not usually severe and nonoperative treatment was typically adequate.
Since then, advances in multiplanar imaging have enabled a
Fractures of the pisiform bone
The pisiform bone is pea shaped with a slightly concave dorsal surface and articulates volarly with the triquetrum. It is not embedded in the FCU, but attaches to the tendon’s anterior surface. Its superficial location at the base of the hypothenar eminence renders it vulnerable to fracture from blunt injury, whereas its multiple soft tissue attachments are thought to account for a susceptibility to avulsion injuries or dislocation.54, 55
It is the last carpal bone to commence ossification, with
Summary
Although they are uncommon injuries, the incidence of hamate and pisiform fractures seems to be increasing because of the popularity of golf and other racquet sports. In the past, missed and delayed diagnosis have been frequent following these injuries. Clinical suspicion is needed to succeed in making an accurate diagnosis and institute timely and appropriate treatment. Special views and advanced imaging are helpful to assess the fracture personality and associated soft tissue and neural
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Cited by (35)
Wrist Fractures
2020, Cooper's Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper ExtremityEvaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?
2019, Acta Orthopaedica et Traumatologica TurcicaCitation Excerpt :The effects of hamate hook excision lead to 4–5 mm of ulnar displacement of the little finger profundus tendon. Flexor tendon force decreases between 11% and 15%.2–4 In addition, depending on the degree of wrist flexion or extension, an increase of 7–11 mm in proximal excursion of the profundus tendon has been reported Demirkan et al17 concluded that the pulley effect of the hamate hook provides a biomechanical advantage for ulnar flexor tendon function and that excision may compromise power grip strength.
Return to Play and Complications After Hook of the Hamate Fracture Surgery
2017, Journal of Hand SurgeryClinical case: surgical treatment for ulnar neuropathy due to pseudoarthrosis of the hook of the hamate
2017, Revista Andaluza de Medicina del DeporteUlnar-Sided Wrist Pain in the Athlete
2016, Orthopedic Clinics of North AmericaPatient with a Hook of the Hamate Fracture Presenting as Vascular Occlusion: Diagnosis Made with Bedside Ultrasound
2016, Journal of Emergency Medicine