FESSH prep Wrist trauma Carpal fractures — hamate
Hook of hamate fractures
Regarding fractures of the hook of the hamate:
1.The hook of the hamate serves as the ulnar bony attachment site for the transverse carpal ligament.
2.A nonunion of the hook of the hamate can lead to attritional rupture of the ring and small finger flexor tendons.
3.A missed hook of hamate fracture commonly presents with persistent ulnar-sided wrist pain.
4.Excision of the ununited hook fragment is the most widely accepted surgical treatment for symptomatic hook of hamate non-union.
5.CT is the imaging modality of choice for confirming an acute hook of hamate fracture when radiographs are equivocal.
FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.
Answer key and explanations — open after answering
-
1. The hook of the hamate serves as the ulnar bony attachment site for the transverse carpal ligament.
True
The hook of the hamate forms the ulnar margin of the carpal tunnel and contributes to the bony attachment of the flexor retinaculum alongside the pisiform; on the radial side the retinaculum attaches to the scaphoid tubercle and trapezium. The hook also functions as a pulley for the ring and small finger flexor tendons.
- Davis DL. Hook of the Hamate: The Spectrum of Often Missed Pathologic Findings. AJR Am J Roentgenol. 2017;209(5):1110-1118. PMID 28834449
-
2. A nonunion of the hook of the hamate can lead to attritional rupture of the ring and small finger flexor tendons.
True
The hook lies in close apposition to the ulnar digital flexor tendons and serves as their pulley at the proximal carpal canal. A fragmented or ununited hook produces a sharp osseous surface that causes attritional tendinopathy and ultimately rupture, most commonly of the flexor digitorum profundus to the small and ring fingers.
- Walsh JJ, Bishop AT. Diagnosis and management of hamate hook fractures. Hand Clin. 2000;16(3):397-403, viii. PMID 10955213
-
3. A missed hook of hamate fracture commonly presents with persistent ulnar-sided wrist pain.
True
A large proportion of hook of hamate fractures are missed on initial presentation, producing a clinical picture of chronic ulnar-sided wrist pain exacerbated by grip, with point tenderness over the hook on volar palpation distal to the pisiform. Ulnar nerve symptoms may co-exist owing to the hook's contribution to the floor of Guyon's canal.
- Urch EY, Lee SK. Carpal fractures other than scaphoid. Clin Sports Med. 2015;34(1):51-67. PMID 25455396
-
4. Excision of the ununited hook fragment is the most widely accepted surgical treatment for symptomatic hook of hamate non-union.
True
Excision eliminates the mechanical irritant, prevents progressive flexor tendinopathy and ulnar nerve symptoms, and permits early return to grip activities. Open reduction and internal fixation is feasible but, in published series, offers little advantage over excision; fixation is selectively considered for acute, large, minimally displaced fragments in high-demand athletes.
- Stark HH, Chao EK, Zemel NP, Rickard TA, Ashworth CR. Fracture of the hook of the hamate. J Bone Joint Surg Am. 1989;71(8):1202-1207. PMID 2777848
- Bishop AT, Beckenbaugh RD. Fracture of the hamate hook. J Hand Surg Am. 1988;13(1):135-139. PMID 3351218
-
5. CT is the imaging modality of choice for confirming an acute hook of hamate fracture when radiographs are equivocal.
True
Davis reports a CT accuracy of 97.2% for hook of hamate fracture diagnosis compared with 80.5% for plain radiography, with axis-oblique reformats demonstrating fracture geometry, displacement and union status not visible on standard wrist projections. MRI complements CT when associated tendinopathy, ulnar neuropathy or vascular injury is suspected.
- Davis DL. Hook of the Hamate: The Spectrum of Often Missed Pathologic Findings. AJR Am J Roentgenol. 2017;209(5):1110-1118. PMID 28834449
- Suh N, Ek ET, Wolfe SW. Carpal fractures. J Hand Surg Am. 2014;39(4):785-791. PMID 24679911