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Hook of Hamate Fracture

43 citationsUpdated Sep 2026
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For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Fractures of the hook of the hamate are infrequently reported in the literature [3], and combined intraarticular fractures involving both the body and hook represent an extremely rare injury pattern that requires a high index of suspicion for diagnosis [1]. Timely and appropriate diagnosis and treatment are essential to prevent long-term complications [2]. The hook of hamate pull test is an easy, cheap, sensitive, and specific clinical examination that can be readily performed to diagnose these fractures [14]. Preoperative evaluation of hook morphology is also relevant, as a hypoplastic hook is common in patients with carpal tunnel syndrome and may help predict adverse events during endoscopic release [13].

Surgical excision is the most-often reported treatment for hamulus nonunion and remains the treatment of choice for athletes, as the high incidence of nonunion precludes the use of open reduction internal fixation [19]. This approach is safe, allows a relatively rapid return to play [4], and results in good postoperative outcomes with a low risk of minor complications for both acute and chronic fractures in professional baseball players [10, 18]. While excision may result in a loss of grip strength [6], it leads to excellent results with return to preinjury levels of activity [7]. In high-level amateur and elite athletes, surgical excision allows successful return to sports participation at preinjury performance levels, achievement of normal function, significant pain reduction, and high patient satisfaction [17, 22]. MLB players can reasonably expect to return to their pre-injury performance levels following operative treatment [12].

For non-displaced acute fractures and delayed unions, dorsal percutaneous cannulated mini-screw fixation is a reliable method that provides safe fixation with minimal morbidity and complications [8, 11]. The simplified dorsal approach using a mini-Acutrak screw allows rigid fixation of the fracture site [26]. Symptomatic partial union should be managed no differently from symptomatic nonunion, with excision of the hook and repair of ligament attachments [5]. The open carpal tunnel approach is a successful technique for open excision due to its familiarity, ease of performance, excellent visualization, and low morbidity [9]. Both surgical procedures yield acceptable outcomes [15], and excision of the fragment results in complete recovery and disappearance of pain [20]. Acute fractures in athletes may be treated with casting or allowed to return to play with nonunion addressed later via excision, while definitive treatment for stress fractures is excision [21]. Hook of hamate regeneration can occur after fracture fragment excision [16].

Anatomy & Pathophysiology

Bony Anatomy

The hamate consists of the body and the hook (hamulus) [49]. The hook of the hamate serves as an attachment for the transverse carpal ligament [49] and the origins of the flexor digiti minimi and opponens digiti minimi [49]. Additionally, the hamate serves as the attachment for the pisohamate ligament [29]. The flexor digitorum superficialis and flexor digitorum profundus tendons run adjacent to the hook of the hamate [29]. The boundaries of Guyon’s canal include the hook of the hamate radially and the pisiform ulnarly [46], and Guyon’s canal contains the ulnar artery and nerve [46]. The incidence of a hypoplastic hook of the hamate is common in patients with carpal tunnel syndrome [13].

Vascular Supply

The hook of the hamate has very few vascular foramina, making this portion of the hamulus relatively avascular [29]. This relative avascularity contributes to the propensity of fractures to progress to nonunions [29].

Pathophysiology & Mechanism

Fractures of the hook of the hamate are traditionally thought to be caused by direct trauma [24]. However, fracture is more likely as a result of a fatigue response that develops in the hook from repetitive load applied by the adjacent deep flexor tendons [24]. Vascular compromise from direct pressure of the tendons on critical local vessels reduces blood flow, leading to mechanical and vascular effects that create pathological osseous change and weakening [24]. These pathological changes predispose to stress fracture and nonunion in repetitive gripping activities [24].

The mechanism of injury for fractures of the hook of hamate is well established in sports involving a bat, club, or racquet [29]. The injury most frequently occurs as the shaft abuts the hook of hamate during contact [29] and occurs more often in the nondominant hand [29]. In baseball, the injury is postulated to occur in the nondominant batting hand because the inferior hand rests on the knob of the bat [29]. Use of the palmar hamate grip demonstrated a 366% increase in pressure exerted on the hook of the hamate compared with the conventional grip [33], and this grip may increase the risk of hook of hamate fracture in NCAA Division I baseball players [33].

High-energy single-impact hamate fractures are likely to occur in otherwise healthy bone without pre-existing stress response [58]. The fatigue response theory is relevant to low-impact repetitive tight gripping activities [58]. Multiple direct traumas in sports can cause a stress fracture with a sudden aggravation of symptoms leading to diagnosis [58].

Complications & Associated Injuries

Chronic, nonunited fractures of the hook of hamate can lead to impingement on the adjacent branch of the ulnar nerve or tendons [29] and fraying of the flexor tendons [29]. Tendon rupture is more likely with midportion fractures due to flexor tendon entrapment and wear [60]. A fragment height ratio greater than 75 and fragment gap less than 2 mm on computer tomography may rule out tear or disruption of the flexor tendons of the ring and little fingers after hamate hook fractures [32]. Conversely, a fragment height ratio between 50–74 with fragment gap greater than 2 mm on computer tomography indicates a high risk of flexor tendon tear or disruption [32]. Fracture of the hamate hook can present as median nerve palsy [59].

Classification

No specific named classification system (e.g., AO/OTA, Schatzker) is provided in the evidence base for hook of hamate fractures. The available data focuses on diagnostic challenges and pathophysiological mechanisms rather than a tiered fracture typing schema.

Diagnostic Challenges: The diagnosis of hook of hamate fracture can be difficult, even for experienced clinicians [31]. Presentation is often delayed secondary to misdiagnosis or "silent" injury [31]. Hamulus fractures may be overlooked in the presence of more radiographically obvious injuries [31]. Imaging of the hamulus on conventional radiographic views is difficult [31].

Pathophysiology: Fracture of the hook of the hamate is more likely as a result of a fatigue response that develops in the hook from repetitive load applied by the adjacent deep flexor tendons [24]. Additional vascular compromise from direct pressure of the tendons on critical local vessels reduces blood flow, leading to both mechanical and vascular effects that create pathological osseous change and weakening [24]. Pathological osseous changes and weakening predispose to stress fracture and nonunion in repetitive gripping activities [24].

Other Considerations: A hypoplastic hook of the hamate is common in patients with carpal tunnel syndrome [13].

Clinical Presentation

History and Mechanism

The mechanism of injury for fractures of the hook of hamate is well established in sports involving a bat, club, or racquet [29]. These injuries can be missed on standard radiographs, which often leads to a delayed presentation [29]. Presentation is frequently delayed secondary to misdiagnosis or "silent" injury [31]. Consequently, the true incidence of hook of hamate fractures could be higher than the estimated 2% to 4% of all carpal fractures [29].

Symptoms and Physical Examination

Hook of hamate fractures can present with a chronic, delayed pattern of vague ulnar-sided wrist pain [29]. On physical examination, volar tenderness on palpation over the hook of hamate was found in 100% of cases in a study of acute fractures [57]. Additionally, the pull test was painful for all patients in that same study of acute fractures [57].

Diagnosis and Imaging

The carpal-tunnel roentgenogram described by Hart and Gaynor offers the best chance of diagnosis if fracture of the hamate is suspected [41]. Computed tomography provides specific metrics for assessing flexor tendon integrity. A fragment height ratio greater than 75 and fragment gap less than 2 mm may rule out tear or disruption of the flexor tendons of the ring and little fingers [32]. Conversely, a fragment height ratio between 50–74 with fragment gap greater than 2 mm indicates a high risk of flexor tendon tear or disruption [32].

Associated Findings and Complications

Preoperative evaluation of the morphology of the hooks and indications for endoscopic carpal tunnel release in cases of hypoplastic hooks may help predict adverse events [13].

Investigations

Plain radiography: Standard radiographs may fail to identify fractures of the hook of hamate, a limitation that can result in delayed presentation [29]. The reported incidence of hook of hamate fractures is 2% to 4% of all carpal fractures, though the true incidence may be higher due to the ease with which the injury is missed or misdiagnosed [29].

MRI: Magnetic resonance imaging is the modality of choice for imaging radiographically occult fractures of the hand and wrist [48].

Treatment

Non-Operative

Acute hook of hamate fractures in athletes may be managed conservatively with casting or by allowing return to play, with any subsequent nonunion addressed later via excision [21]. Ultrasound treatment is considered one option for nonunion of the hook of the hamate caused by repeated stress [25].

Operative

Indications: Excision is the definitive treatment for stress fractures [21].

Surgical Approach / Technique: A modified surgical approach through Guyon’s Canal and the proximal ulnar border of the carpal tunnel allows direct visualization of vital structures most at risk, including the motor branch of the ulnar nerve, unlike blind or unilateral approaches, and preserves the nerve supply and blood supply to the hypothenar muscles [30]. Meticulous adherence to the described surgical technique tailored to athletes optimizes clinical outcomes and avoids complications [23].

Fixation: The dorsal percutaneous approach is a reliable method that provides safe fixation of non-displaced fractures of the hook of hamate, as confirmed by cadaveric study [11].

Other Considerations: Hook of hamate excision in baseball players is associated with high return-to-play rates and short return-to-play time, typically occurring between 5 and 7 weeks after surgery [35]. Thirteen studies reported performance level before and after return to play, with 91.2% (506/555) of patients demonstrating similar or improved performance [37]. Patient outcomes were good to excellent regardless of the treatment chosen, with minimal pain and good hand functionality [27].

Complications

Nonunion and Avascularity

The hook of the hamate possesses very few vascular foramina, rendering this portion of the hamulus relatively avascular [29]. This relative avascularity contributes to the propensity of hook of hamate fractures to progress to nonunions [29]. Fractures of the hook of the hamate are more likely as a result of a fatigue response that develops in the hook from repetitive load applied by the adjacent deep flexor tendons [24]. These changes are likely to predispose to stress fracture and nonunion in repetitive gripping activities [24]. The incidence of nonunion precludes the use of open reduction internal fixation for hook of hamate fractures in athletes [19].

Nerve and Tendon Complications

Chronic, nonunited fractures of the hook of hamate can lead to impingement on the adjacent branch of the ulnar nerve [29]. Additionally, chronic, nonunited fractures of the hook of hamate can lead to impingement on adjacent tendons [29].

Post-Excision Outcomes and Complications

Excision of the hook of hamate may result in a loss of grip strength [6]. Despite appropriate treatment, some residual symptoms are not uncommon, particularly following excision [31]. Surgical excision is associated with a low risk of minor complications for both acute and chronic hook of hamate fractures in professional baseball players [18]. Hook of hamate excision and ulnar tunnel decompression provide good outcomes with minimal complications [28].

Recovery

Light activity (weeks): The provided evidence does not specify a timeline for light activity, desk work, driving, or light activities of daily living.

Full activity (months): Hook of hamate excision and ulnar tunnel decompression provide good outcomes with minimal complications and early return to play [28].

Complete recovery / outcome plateau (months): The provided evidence does not specify a timeline for complete recovery, pain stabilization, or final functional outcome plateau.

Rehabilitation protocol: The provided evidence does not specify a rehabilitation protocol, including PT phasing, immobilisation duration, weight-bearing/ROM progression, or sling/brace removal timing.

Functional milestones: The provided evidence does not specify validated PROM trajectories or outcome-measure benchmarks.

Other Considerations: Chronic, nonunited fractures of the hook of hamate can lead to impingement on the adjacent branch of the ulnar nerve or tendons as well as fraying of the flexor tendons [29]. The open carpal tunnel approach is a successful technique for open excision of symptomatic ununited hook of hamate fractures, owing to its familiarity, ease of performance, excellent visualization, and low morbidity [9]. Non-displaced acute fractures and delayed union of the hamate hook can be treated successfully by dorsal percutaneous cannulated mini-screw fixation with minimal morbidity and complications [8]. Ultrasound treatment might be useful for nonunion of the hook of hamate caused by repeated stress, and is considered one option in various treatment methods [25].

Key Evidence

  • [L5] Combined intraarticular fracture of the body and hook of hamate is an extremely rare injury pattern requiring a high index of suspicion for diagnosis. [1] (10.1007/s12593-012-0070-2)
  • [L4] Appropriately diagnosing and treating hook of the hamate fractures in a timely manner after injury can prevent long-term complications. [2] (10.2519/jospt.2010.0408)
  • [L4] Fractures of the hook of the hamate have been infrequently reported in the literature. [3] (10.1016/0020-1383(89)90169-1)
  • [L4] In most cases, surgical excision as treatment for hook of the hamate fractures is safe and allows a relatively rapid return to play. [4] (10.1016/j.jhsa.2017.06.108)
  • [L4] This condition should be managed no differently from a symptomatic nonunion, with excision of the hook of the hamate and repair of the ligament attachments. [5] (10.1177/03635465030310010201)
  • [L5] Excision of the hook of hamate is the most-often reported treatment for hamulus nonunion, with successful return to sport in athletes, though it may result in a loss of grip strength. [6] (10.1016/j.jhsa.2013.06.004)
  • [L4] Early and late surgical excision of the hook of the hamate leads to excellent results with return to preinjury levels of activity. [7] (10.1053/j.otsm.2010.03.003)
  • [L4] This pilot study demonstrates that non-displaced acute fractures and delayed union of the hamate hook can be treated successfully by dorsal percutaneous cannulated mini-screw fixation with minimal morbidity and complications. [8] (10.1142/s0218810412970039)
  • [Paper] The study highlights the open carpal tunnel approach as a successful technique for open excision of symptomatic ununited hook of hamate fractures, because of its familiarity, ease of performance, excellent visualization and low morbidity. [9] (10.1016/j.injury.2014.05.008)
  • [L4] Surgical excision of the hook of the hamate resulted in good postoperative outcomes with a mean follow-up of 6 years. [10] (10.3109/17453679308993670)
  • [L5] The cadaveric study confirms that the dorsal percutaneous approach is a reliable method and provides safe fixation of non-displaced fractures of the hook of hamate. [11] (10.1177/1753193421991761)
  • [L3] MLB players sustaining hook of hamate fractures can reasonably expect to return to their pre-injury performance levels following operative treatment. [12] (10.1123/jsr.2017-0071)
  • [L4] The incidence of a hypoplastic hook of the hamate is common in patients with carpal tunnel syndrome, and preoperative evaluation of the morphology of the hooks and indications for endoscopic carpal tunnel release in cases of hypoplastic hooks may help predict adverse events. [13] (10.1016/j.jhsg.2023.12.010)
  • [L4] The hook of hamate pull test is an easy, cheap, sensitive, and specific test that can be readily performed in the clinic to diagnose hook of hamate fractures. [14] (10.1016/j.jhsa.2010.08.024)
  • [L4] Both surgical procedures appear to yield acceptable outcomes in the treatment of hook of hamate fractures. [15] (10.1016/j.jhsg.2023.11.011)
  • [L4] Hook of hamate regeneration can occur after fracture fragment excision. [16] (10.1016/j.jhsg.2024.08.008)
  • [L4] Surgical excision of hook of hamate fractures in high-level amateur athletes allows for successful return to sports participation at preinjury performance levels, achievement of normal function as measured by validated objective outcome measures, significant reduction in pain, and high overall patient satisfaction. [17] (10.1016/j.jhsa.2012.10.011)
  • [L4] Surgical excision remains an effective method of management, with a low risk of minor complications for both acute and chronic hook of hamate fractures in professional baseball players. [18] (10.1016/j.jhsa.2021.03.015)
  • [L5] Surgical excision is the treatment of choice for fractures of the hook of the hamate in any athlete, as the incidence of nonunion precludes the use of open reduction internal fixation. [19] (10.1016/j.hcl.2012.05.013)
  • [L4] Excision of the fragment is the best choice for nonunion of the hook of the hamate, resulting in complete recovery and disappearance of pain, although sportsmen generally return to their sports activity. [20] (10.1007/s001670100246)
  • [L5] Acute hook of hamate fractures in athletes may be treated with casting or allowed to return to play with nonunion addressed later via excision; definitive treatment for stress fractures is excision. [21] (10.1016/j.hcl.2012.05.012)
  • [L4] Surgical excision of hook of hamate fractures in elite baseball players showed a very high rate of return to play within 6 weeks. [22] (10.1177/23259671211038028)
  • [L4] Meticulous adherence to the described surgical technique tailored to athletes optimizes clinical outcomes and avoids complications. [23] (10.1177/2325967121s00552)
  • [L5] [24] (10.1177/17531934241235803)
  • [L4] Ultrasound treatment might be useful for nonunion of the hook of the hamate caused by repeated stress, and we consider that the ultrasound treatment for nonunion of the hook of the hamate is one option in various treatment methods. [25] (10.1007/s00167-003-0425-0)
  • [L4] The authors conclude that the simplified dorsal approach with percutaneous fixation using a mini-Acutrak screw is effective for reduction and fixation of the hamate hook, allowing rigid fixation of the fracture site. [26] (10.3109/02844310801956714)
  • [L4] Patient outcomes were good to excellent regardless of the treatment chosen, with minimal pain and good hand functionality. [27] (10.1177/1753193417729603)
  • [L4] Hook of hamate excision and ulnar tunnel decompression provide good outcomes, with minimal complications and early return to play. [28] (10.1007/s11552-013-9527-4)
  • [L4] [29] (10.1177/2325967118803090)
  • [L4] This modified approach allows direct visualization of the vital structures most at risk, including the motor branch of the ulnar nerve, unlike blind or unilateral approaches, and preserves the nerve supply and blood supply to the hypothenar muscles. [30] (10.1016/j.jhsa.2019.07.015)
  • [L5] [31] (10.1016/s0749-0712(21)00581-3)
  • [L4] A fragment height ratio greater than 75 and fragment gap less than 2 mm in computer tomography may rule out tear or disruption of the flexor tendons of the ring and little fingers after hamate hook fractures, and a fragment height ratio between 50–74 with fragment gap greater than 2 mm indicates a high risk of flexor tendon tear or disruption. [32] (10.1177/1753193418823503)
  • [L4] Use of the palmar hamate grip demonstrated a 366% increase in pressure exerted on the hook of the hamate compared with the conventional grip, suggesting it may increase the risk of hook of the hamate fracture in NCAA Division I baseball players. [33] (10.1177/23259671211045043)
  • [L4] Hook of hamate excision in baseball players is associated with high RTP rates and short RTP time, typically occurring between 5 and 7 weeks after surgery. [35] (10.1177/03635465261452783)
  • [L1] Thirteen studies reported performance level before and after return to play, with 91.2% (506/555) of patients demonstrating similar or improved performance. [37] (10.1177/15589447241231303)
  • [Case_report] The carpal-tunnel roentgenogram described by Hart and Gaynor would seem to offer the best chance of diagnosis if fracture of the hamate is suspected. [41] (10.2106/00004623-197557020-00027)
  • [L4] [57] (10.1016/j.jhsa.2019.01.014)
  • [L5] [58] (10.1177/17531934241304249)
  • [L4] Good results were achieved by excising the fragment through a carpal tunnel incision. [59] (10.1007/s004020050222)
  • [L4] The authors conclude that tendon rupture is more likely with midportion fractures due to flexor tendon entrapment and wear, though further studies with larger samples are warranted to verify these preliminary conclusions. [60] (10.1016/j.jhsa.2013.11.020)

See Also

References

[1] Combined Intraarticular Fracture of the Body and the Hook of Hamate: An Unusual Injury Pattern. Journal of Hand and Microsurgery. 2013. DOI: 10.1007/s12593-012-0070-2

[2] Hook of the Hamate Fracture. Journal of Orthopaedic & Sports Physical Therapy. 2010. DOI: 10.2519/jospt.2010.0408

[3] Fractures of the hook of the hamate. Injury. 1989. DOI: 10.1016/0020-1383(89)90169-1

[4] Return to Play and Complications After Hook of the Hamate Fracture Surgery. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.108

[5] Symptomatic, Partial Union of the Hook of the Hamate Fracture in Athletes. The American Journal of Sports Medicine. 2003. DOI: 10.1177/03635465030310010201

[6] Hook of Hamate Fractures. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.06.004

[7] Hook of the Hamate Fractures. Operative Techniques in Sports Medicine. 2010. DOI: 10.1053/j.otsm.2010.03.003

[8] DORSAL PERCUTANEOUS CANNULATED MINI-SCREW FIXATION FOR FRACTURES OF THE HAMATE HOOK. Hand Surgery. 2012. DOI: 10.1142/s0218810412970039

[9] Surgical excision of ununited hook of hamate fractures via the carpal tunnel approach. Injury. 2014. DOI: 10.1016/j.injury.2014.05.008

[10] Fractures of the hook of the hamate in athletes: 8 cases followed for 6 years. Acta Orthopaedica Scandinavica. 1993. DOI: 10.3109/17453679308993670

[11] Safety and reliability of the dorsal percutaneous approach for non-displaced hook of hamate fracture: an anatomical study. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193421991761

[12] Performance Outcomes After Hook of Hamate Fractures in Major League Baseball Players. Journal of Sport Rehabilitation. 2018. DOI: 10.1123/jsr.2017-0071

[13] Anatomic Variation of the Hamate Hook as a Potential Risk in Endoscopic Carpal Tunnel Release. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.12.010

[14] Hook of Hamate Pull Test. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.08.024

[15] Surgical Management of Hook of Hamate Fractures: A Systematic Review of Outcomes. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.11.011

[16] Hook of Hamate Regrowth After Surgical Excision: A Report of Two Cases. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.08.008

[17] Outcomes of Hook of Hamate Fracture Excision in High-Level Amateur Athletes. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.10.011

[18] Hook of Hamate Fractures in Major and Minor League Baseball Players. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.03.015

[19] Treatment of Fracture of Hook of the Hamate in Baseball Players. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.013

[20] Hook of the hamate nonunion: suspicion of stress‐induced mechanism in a hockey player. Knee Surgery, Sports Traumatology, Arthroscopy. 2001. DOI: 10.1007/s001670100246

[21] Hook of Hamate and Pisiform Fractures in Basketball and Hockey Players. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.012

[22] Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671211038028

[23] PAPER 14: Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00552

[24] The aetiology of fracture and nonunion in the hook of the hamate. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241235803

[25] Ultrasound treatment of nonunion of the hook of the hamate in sports activities. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-003-0425-0

[26] Simplified dorsal approach to fracture of the hamate hook with percutaneous fixation with screws. Journal of Plastic Surgery and Hand Surgery. 2010. DOI: 10.3109/02844310801956714

[27] Diagnosis and management of hook of hamate fractures. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417729603

[28] Hook of Hamate Fractures in Competitive Baseball Players. HAND. 2013. DOI: 10.1007/s11552-013-9527-4

[29] Return to Play After Hook of Hamate Excision in Baseball Players. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118803090

[30] A Modified Surgical Approach Through Guyon’s Canal and the Proximal Ulnar Border of the Carpal Tunnel Allows for Safe Excision of the Hook of the Hamate. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.07.015

[31] DIAGNOSIS AND MANAGEMENT OF HAMATE HOOK FRACTURES. Hand Clinics. 2000. DOI: 10.1016/s0749-0712(21)00581-3

[32] Computerized tomographic prediction of flexor tendon injuries complicating hamate hook fractures. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193418823503

[33] Pressures Exerted on the Hook of the Hamate in Collegiate Baseball Players: A Comparison of Grips, With Emphasis on Fracture Prevention. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/23259671211045043

[35] Return to Play After Hook of Hamate Excision in Baseball Players: A Systematic Review. The American Journal of Sports Medicine. 2026. DOI: 10.1177/03635465261452783

[37] Return to Play After Hook of Hamate Fracture: A Systematic Review and Meta-Analysis. HAND. 2024. DOI: 10.1177/15589447241231303

[41] Fracture of the hook of the hamate. A case report. The Journal of Bone & Joint Surgery. 1975. DOI: 10.2106/00004623-197557020-00027

[46] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > FRACTURES AND DISLOCATIONS OF THE DISTAL AND MID-FOREARM.

[48] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Imaging: Advances in Imaging of the Hand and Upper Extremity > Magnetic Resonance Imaging.

[49] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Hand and Wrist > VII. The Wrist.

[57] Minimally Invasive Fixation With a Volar Approach Using a Cannulated Compression Screw for Acute Hook of Hamate Fractures. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.01.014

[58] Re: Campbell FC, Jones SW, Campbell DA. The aetiology of fracture and nonunion in the hook of the hamate. J Hand Surg Eur. 2024, 49: 1172-8. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241304249

[59] Fracture of the hamate hook presenting as median nerve palsy. Archives of Orthopaedic and Trauma Surgery. 2005. DOI: 10.1007/s004020050222

[60] Hook of Hamate Fractures: Location and Tendon Rupture. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.11.020

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d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.