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Gary R Kuzma, MD and Matthew Weingold, MD, Greensborok NC
Recommended treatment for fractures of the hamate hook has been excision with the expectation of a good result. Complications occur in approximately three percent of cases. These are usually due to exposure with injury of the ulnar or median nerve or ulnar artery being reported. Osteonecrosis of the fractured fragment which lacks a vascular foramina in 29% is hypothesized to contribute to a high incidence of non-union. Rupture of the flexor tendons to the little finger has been reported to be as high as 14% in patients with hook non-union. Recently, studies have suggested that the hook forms a pulley for the flexor tendons and excision may result in diminished grip strength. We report 5 cases of hamate hook fractures treated with reduction and fixation using headless screws.
The average age was 34.8 yrs (29-39 yrs). The time from injury to operation varied from 1 week to 6 months. The fracture was in the middle 1/3 in 4 of 5 cases. The dominant hand was involved in 2 cases. Bone graft was not used in any case. Volar exposure isolated the tip of the hook with retraction of the ulnar artery and nerve.
Follow-up averaged 22.8 months (3 - 36 months). All patients were satisfied with their results and returned to their regular job. All fractures healed.
Range of motion to the fingers was full. Wrist palmar flexion averaged 65.8 degs (98% opposite), dorsi-flexion averaged 58 degs (90% opposite), radial deviation averaged 27.6 degs (97% opposite) and ulnar deviation averaged 42.8 degs (100% opposite). Grip strength averaged 94.2 lbs compared to 100.4 lbs in the non-operated hand.
There were no post-operative complications.
Reduction and fixation of fractures of the hook of the hamate can be safely performed.
We have not seen a loss of grip strength following fixation. The use of headless screws allows the ulnar artery and nerve to assume the normal anatomical position over the hook without the interference and mass of a screw head.
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