Hamate (Hook) Fracture

ExitCare ImageThe hamate is a bone in the hand that has the "hamate hook," a bony bump (prominence), that is vulnerable to injury. A hamate fracture is a complete or incomplete break of this bone.

SYMPTOMS

  • Pain or soreness on the little finger side (ulnar) of the wrist, on the palm side, or sometimes on the back side.

  • Pain, tenderness, swelling, and occasionally bruising around the fracture site, at the base of the wrist.

  • Pain with gripping or swinging a golf club, bat, or racquet.

  • Numbness and coldness in the hand.

  • Swelling in the hand, causing pressure on the blood vessels or nerves.

CAUSES

A hamate fracture is usually the result of direct hit (trauma) to the base of the palm from a grasped object, such as the end of a golf club, baseball bat, or racquet.

RISK INCREASES WITH:

  • Sports in which a bat (baseball, cricket), club (golf), or racquet (tennis, racquetball) are used.

  • History of bone or joint disease, including osteoporosis, or previous hand restraint.

PREVENTION

  • Maintain physical fitness:

  • Hand and forearm strength.

  • Flexibility and endurance.

  • When playing risky sports, wear appropriately fitted and padded protective equipment, such as padded gloves, or use clubs, racquets, and bats with padded grips.

  • Learn and use proper technique when hitting or swinging a bat, racquet, or club.

  • If you had a previous injury, use tape or padding to protect your hand before playing contact or jumping sports.

PROGNOSIS

Hamate fractures may heal with restraint. However, the function of blood vessels in the area causes hamate injuries to have a decreased ability to heal. Surgery may be performed to remove the broken piece, with a return to sports after 6 to 10 weeks.

RELATED COMPLICATIONS

  • Fracture does not heal (nonunion), common.

  • Fracture heals in a poor position (malunion).

  • Impaired blood supply to the fracture and bones.

  • Chronic pain, stiffness, or swelling of the hand and wrist, especially with prolonged casting.

  • Nerve injury to the hand, causing pain, numbness, and weakness or clumsiness in the hand and fingers.

  • Excessive bleeding in the hand, causing pressure and injury to nerves and blood vessels (rare).

  • Tearing (rupture) of the tendons that bend the wrist or fingers.

  • Risks of surgery: infection, bleeding, injury to nerves (numbness, weakness), nonunion, malunion, arthritis, stiffness, and pain.

TREATMENT

Forbones that are in proper alignment (non-displaced fracture), treatment first involves ice, medicine, and elevation to reduce pain and inflammation. Restraint of the hand and wrist is advised for 6 to 8 weeks, to allow the bones to heal. If the fractured bones are out of alignment (displaced), surgery is advised to either remove the broken piece or fix it with screws and pins. After surgery, the injury is restrained. After restraint (with or without surgery), stretching and strengthening exercises for the injured and weakened joint and muscles are needed. Exercises may be completed at home or with a therapist. Depending on the sport and the position played, a brace or splint may be advised at first, when returning to sports.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers are usually prescribed only after surgery. Use only as directed and only as much as you need.

COLD THERAPY

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse, despite treatment.

  • You experience pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery: fever, increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)