$hamate bone fracture$

Curvilinear skin incision for approach to the hook of hamate, centered over the hook of hamate and Guyon’s canal, is shown.ĭissection is taken through subcutaneous tissue to the palmaris brevis, which is divided at its radial aspect as it becomes confluent with fascia (Figure 4). If a callus is present, the incision should be made through it so as not to impede visualization. Surgical techniqueįollowing prepping and draping, a curvilinear skin incision is made over the hook of the hamate and Guyon’s canal (Figure 3). It is subtly palpable one fingerbreadth distal and radial to the more easily palpable pisiform (blue circle). Location of the hook of hamate (purple circle) is shown. Therefore, both branches must be visualized and protected in the approach to the hook of hamate - both the superficial branch coursing with the ulnar artery and the deep branch, which is only visible once these superficial structures are retracted. Surgeons must be aware that the superficial and deep branches diverge proximal to the hook of hamate. The superficial sensory branch supplies sensation to the fourth webspace and small finger while the deep motor branch innervates the hypothenar muscles, interossei and third/fourth lumbricals. On its ulnar aspect and superficial to the hamate lies Guyon’s canal, which contains the ulnar artery and superficial sensory and deep motor branches of the ulnar nerve. As the ulnar border of the carpal tunnel, its radial aspect is adjacent to the flexor tendons. It is the origin of the transverse carpal ligament. The hook of hamate, or hamulus, is located one fingerbreadth distal and radial to the more clearly palpable pisiform (Figure 2). Therefore, this has become the preferred treatment strategy used in athletes. Fragment excision has been shown to have a high rate of rapid return to play with low rates of complications and return to the OR. In high-demand athletes, consistent results with a fast return to play is highly sought after. Open reduction and internal fixation, another accepted technique, can also have less desirable outcomes, with nonunion or hardware irritation among them. Nonoperative management was historically a primary option for hook of hamate fractures, but it has shown mixed results. Axial CT cut shows a nondisplaced hook of hamate fracture (white arrow). CT scan can confirm the diagnosis and inform chronicity or evidence of healing (Figure 1).ġ.

$hamate bone fracture$ $hamate bone fracture$

Radiographs, specifically carpal tunnel views, may provide the diagnosis. Diagnosis is often delayed due to an insidious onset and vague presentation. As a source of pain at a key anatomic area for these athletes, these fractures can limit performance. These may occur due to repetitive stress on the hypothenar eminence of the hand from a bat, club or racket in sports such as baseball, golf or tennis. Hook of hamate fractures, while uncommon in the general population, are more common among athletes. If you continue to have this issue please contact to Healio

$hamate bone fracture$

Hamate bone fracture