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钩骨钩骨折

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Updated Oct 2026
Illustration: wrist

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的感受

钩骨钩骨折发生在一瞬间。常见原因是手掌一侧、靠近小指根部的部位受到直接撞击。这种损伤常见于棒球运动员和高尔夫球手，因为球棒、球杆或球拍会重重压在这个部位上。通过手掌韧带和肌腱传导的突然外力也可能导致这种骨折。

受伤后，您会立即感到手掌一侧、靠近小指的根部疼痛。该部位一按就痛。在大多数急性骨折中，每次都会出现这种压痛。用手推或拉时会疼，因此握住门把手、端着咖啡杯或拧瓶盖都会变得困难。您可能会注意到肿胀。疼痛起初是尖锐的刺痛，随后转为深部的酸痛。

最初的几天和几周可能会令人沮丧。使用手时会疼，而且早期的酸痛可能会影响您的睡眠。这种损伤很少见，而且在常规手腕X光片上往往显示不出来。这意味着它起初可能被漏诊，尤其是当X光片看起来正常时。如果您的症状符合这种表现，特殊角度的X光片或CT扫描可以发现骨折。CT扫描对这种损伤的诊断非常准确。

有些警示信号需要紧急处理。如果您的手或手臂变得发热、发红、肿胀并疼痛，尤其是伴有发烧时，请当天前往急诊科。如果损伤部位皮肤破损、有骨头外露或明显畸形，请当天前往急诊科。如果您的手指或手部变得苍白、冰冷、发白或发蓝，或者突然失去感觉或无法活动，请当天前往急诊科。

如果您的症状没有缓解、在数周内逐渐加重、在夜间将您痛醒，或使您无法工作或使用手部，请去看全科医生或要求专科医生评估。如果在下班时间或周末无法联系到诊所，请前往离您最近的急诊科。

实际发生了什么

在您手腕深处的手掌一侧，有一块叫作钩骨的弯曲小骨头。它有一个小小的钩状骨突，向前伸入您的手掌。这个钩状突起是部分活动小指的韧带和肌肉的附着点，您抓握时，手指肌腱正好贴着它滑动。

当您摔倒时用手撑地，或挥动球棒、球杆或球拍时，这个钩状突起会承受应力。一次重击就可能使它出现裂缝。重复同样的挥击动作成千上万次，也可能使它逐渐磨损直到断裂，就像一枚回形针被来回弯折后最终断开一样。这块骨头很小，在手腕骨骨折中只有约 2% 发生在这里。

钩状突起的血液供应较差，这一点很重要。和其他组织一样，骨头需要血液才能重新长合。抓握时钩状突起也会移动，因为压在它上面的肌腱会使断端不断移位。一个不断移动、血流又少的骨折往往难以愈合。医生称之为骨不连，意思是骨头始终没有长合。

如果断裂的骨块保持在正常位置，只要早期将手部固定不动，骨头仍然可以长合。如果骨块已经分离移位，或者骨折发现得较晚，单纯靠自然愈合的可能性就会降低。在这种情况下，治疗通常意味着要么用一枚小螺钉将骨头固定在一起，要么将钩状突起完全切除。切除听起来很激进，但手部在没有这个小钩状突起的情况下也能很好地发挥功能，许多人都能恢复到原来的运动水平。

还有一点值得了解。断裂的钩状突起粗糙、未愈合的边缘正好贴着您的手指肌腱。随着时间推移，它可能会磨损肌腱，就像绳子在锋利的岩石上摩擦一样。如果肌腱断裂，就会切除断裂的钩状突起并将残端磨平，使肌腱能够重新发挥作用。

我们可以采取的措施

Dr Kieran Hirpara 是 Mater Private Hospital Rockhampton 的上肢外科医生，他会根据您的具体损伤选择治疗方案。有些钩骨钩骨折无需手术即可愈合，有些则需要尽快手术，因此及时评估很重要。患者通常由全科医生（GP）转诊到我们诊所；如果是物理治疗师建议您来看我们，您仍需要全科医生开具转诊信，才有资格获得 Medicare 报销。在诊所，我们会询问病史、检查您的手部，并在需要时安排影像学检查。由于这种骨折在常规X光片上往往难以发现，我们可能会使用特殊角度的X光片或CT扫描来清楚地显示它。

如果断裂的骨块保持在正常位置，且骨折发现得早，我们可能会用夹板或石膏将您的手固定不动，让骨头长合。我们会通过复查影像来监测愈合情况，您的手部治疗师，即 Extend Rehabilitation 的 Ruby Doolan，会为您制作所需的任何夹板，并在适当阶段指导您恢复活动。运动员有时会选择带着骨折继续比赛，日后再处理未愈合的骨块，我们会与您详细讨论这对您意味着什么。

如果骨块已经分离移位，或者骨折不稳定，我们可能会从一开始就建议手术。一种方案是切除钩状骨突，这能让您相对较快地重返运动。另一种方案是用一枚小螺钉将骨头固定在一起，对于较年轻的患者，我们可能会建议这种方案，以保持握力。在任何一种手术中，我们都力求保护附近的神经和血液供应。在这些方案之间做出选择是真正的共同决定：有时夹板可能有效，但疼痛或骨头最终的位置可能不适合您的手或您的运动。

无论您选择哪种方案，最初几周的情况都相似。我们会帮助您控制疼痛，您则需要在手部愈合期间保护好它。与 Ruby 一起进行的手部治疗会在适当阶段开始，使您的握力和活动能够安全地恢复。如果您的症状没有缓解、在数周内逐渐加重、在夜间将您痛醒，或使您无法工作或使用手部，请去看全科医生或要求专科医生评估。

预期情况

愈合情况取决于您目前处于哪个阶段。如果骨折发现得早且骨块保持在正常位置，用夹板或石膏将手固定不动，可以给骨头长合的机会。如果骨折发现得晚，或者骨块已经移位，骨头可能永远无法自行长合。在这种情况下，手术通常意味着要么用一枚小螺钉将骨头固定在一起，要么将钩状突起完全切除。

如果您接受切除钩状突起的手术，大多数人都能相对较快地重返运动。对于高水平业余运动员，手术使他们能够以受伤前的运动表现水平重返运动，测试显示手部功能正常，疼痛减轻，并对结果感到满意。一名职业保龄球运动员在钩状突起切除后 2.5 个月时手部功能已令人满意。早期手术和晚期手术都能使患者恢复到受伤前的活动水平。用螺钉将骨头固定在一起也可以取得良好效果，术后问题很少；对未愈合的骨折进行修复可以保持握力，并完全消除疼痛。

恢复是一个逐步回归的过程，而不是一下子就好。起初您的手会酸痛，这种酸痛会在数周内逐渐缓解。随着手部重新使用，在手部治疗师的指导下，握力会逐渐恢复。随着肌腱不再受到断裂骨块的刺激，端杯子或转动钥匙等日常活动会变得更容易。

有些风险需要如实告知。钩状突起的血液供应较差，因此愈合缓慢或不愈合是主要的担忧。如果骨头没有长合，粗糙的边缘可能会摩擦您的手指肌腱。小指肌腱断裂可能发生在最初受伤后 6 个月到 25 年之间的任何时候，断裂后的握力平均为另一只手的 83%。如果肌腱确实断裂，就会切除断裂的钩状突起并将残端磨平，使肌腱能够重新发挥作用。手术本身发生轻微并发症的风险较低。如果您的症状没有缓解、在数周内逐渐加重、在夜间将您痛醒，或使您无法工作或使用手部，请去看全科医生或要求专科医生评估。

何时就医

如果损伤部位有开放性伤口、有骨头外露或明显畸形，请寻求紧急医疗救治。如果您的手指或手部变得苍白、冰冷、发白或发蓝，或者突然失去感觉或无法活动，请当天前往急诊科。出现这些信号需要去急诊科，而不是在普通诊所的候诊室里等待。

其他情况请先去看全科医生。如果疼痛没有缓解，或者随着骨头愈合，肿胀、活动或握力没有逐周改善，请要求专科医生评估。这种损伤在常规X光片上难以发现，因此第一次检查结果正常并不能排除它。CT扫描在 95% 的情况下能发现这种骨折，及早获得诊断可以在日后保护您的握力和肌腱。

Reviewed by AI synthesis (v2) — pending human review · 15 September 2026.

Want the clinical detail? Read the clinician version.

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For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

  • Hook of hamate fractures are rare injuries [7, 15].
  • The most usual mechanism for hook of hamate fractures is a direct blow to the area of the hook [7, 15].
  • Fractures of the hook of the hamate have been infrequently reported in the literature [2].
  • Hook of hamate fractures with normal standard x-rays may be difficult to diagnose, especially for a nonhand surgeon [1].
  • A specific radiographic view is recommended in addition to standard views in all cases of suspected fractures of the hook of the hamate [8].
  • The incidence of acute hook of hamate fracture in association with high-energy distal fractures in patients undergoing CT evaluation of the wrist is 2.7% [18].
  • Hamate hook fractures can be successfully treated acutely by immediate immobilization [3].
  • 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 [5].
  • The dorsal percutaneous approach is a reliable method that provides safe fixation of non-displaced fractures of the hook of hamate [23].
  • Surgical excision as treatment for hook of hamate fractures is safe and allows a relatively rapid return to play in most cases [4].
  • Surgical excision of the hook of the hamate resulted in good postoperative outcomes with a mean follow-up of 6 years in athletes [19].
  • Early and late surgical excision of the hook of the hamate leads to excellent results with return to preinjury levels of activity [13].
  • 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 [27].
  • 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 [30].
  • The treatment of choice for a symptomatic nonunion, and possibly for an acute fracture, appears to be surgical excision of the hook of the hamate [9].
  • Symptomatic partial union of the hook of the hamate fracture in athletes should be managed with excision of the hook of the hamate and repair of the ligament attachments [10].
  • The open carpal tunnel approach is a successful technique for open excision of symptomatic ununited hook of hamate fractures due to its familiarity, ease of performance, excellent visualization, and low morbidity [22].
  • Both surgical procedures appear to yield acceptable outcomes in the treatment of hook of hamate fractures [11].
  • Repair by open reduction and internal fixation for ununited fracture hook of the hamate is feasible and desirable for preservation of grip strength and complete relief of pain [14].
  • In younger patients with nonunion of the hook of the hamate, repair of the nonunion rather than simple excision should be aimed for to preserve grip strength [20].
  • Hook of hamate regeneration can occur after fracture fragment excision [12].
  • The incidence of a hypoplastic hook of the hamate is common in patients with carpal tunnel syndrome [47].

Anatomy & Pathophysiology

Bony Anatomy

  • The hamate consists of a body and a hook (hamulus) [59].
  • The hook of the hamate serves as an attachment site for the transverse carpal ligament [59].
  • The hook of the hamate serves as an origin for the flexor digiti minimi and opponens digiti minimi muscles [59].
  • The distal end of the transverse carpal ligament is located 10 mm from the hook of the hamate [36].
  • The boundaries of Guyon’s canal include the hook of the hamate radially and the pisiform ulnarly [56].

Vascular Supply

  • The extraosseous blood supply to the carpus is provided by terminal branches of the radial, ulnar, and anterior interosseous arteries through dorsal and palmar transverse arterial arches [62].
  • The dorsal intercarpal arch is the largest of the dorsal arches and supplies the distal carpal row [62].
  • The deep palmar arch at the level of the metacarpal bases is consistent and communicates with the dorsal basal metacarpal arch and palmar metacarpal arteries [62].
  • The hamate hook has a poor blood supply, which is a main reason for the increased risk of nonunion [48].
  • The hamate hook is vulnerable to osteonecrosis and nonunion due to its vascularity [3].

Ligamentous Anatomy

  • The capitohamate ligament is a thick ligament with a cross-section of 5 × 5 mm [57].
  • The capitohamate ligament has extensions to the third or fourth metacarpals [57].
  • The distal row of carpal bones is rigid with little motion between its bones due to stout intercarpal ligaments [57].

Biomechanics & Kinematics

  • The hamate is part of the central column of the wrist, which controls flexion-extension of the wrist [60].
  • The hamate is part of the metacolumn in Weber's three-column theory, which includes the triquetrum and hamate [60].
  • The lunate, capitate, hamate, trapezium, and trapezoid function collectively as the "stable central column" in the Sandow et al. model [60].
  • The hamate hook provides a biomechanical advantage for flexor tendon function [43].
  • Cadaveric changes in tendon force after hamate hook excision suggest that power grip may be decreased [43].
  • No significant change in the position of deep or superficial digital flexor tendons relative to the hook of hamate was noted with finger extension or flexion [49].

Pathophysiology & Injury Mechanisms

  • Hook of hamate fractures are traditionally thought to be caused by direct trauma [69].
  • Fracture of the hook of hamate is more likely to result from a fatigue response due to repetitive load applied by adjacent deep flexor tendons [69].
  • Direct pressure of tendons on critical local vessels reduces blood flow, leading to mechanical and vascular effects that create pathological osseous change and weakening [69].
  • These pathological changes predispose to stress fracture and nonunion in repetitive gripping activities [69].
  • High-energy single-impact hamate fractures likely occur in otherwise healthy bone without pre-existing stress response [72].
  • Fractures of the hook of the hamate can occur by direct impact applied to the hamate during a fall on the heel of the hand [48].
  • Fractures of the hook of the hamate can occur by microtraumatism in sports requiring repeated use of a racquet or a bat [48].
  • The growing popularity of golf and other racquet sports has led to an increase in stress fractures of the hamate hook [48].
  • Mobility of the fracture site is a main reason for the increased risk of nonunion of the hamate hook [48].
  • Delayed diagnosis is a main reason for the increased risk of nonunion of the hamate hook [48].
  • Combined fracture of the hook of the hamate and palmar dislocation of the fifth carpometacarpal joint results from a sudden, violent contraction of the flexor carpi ulnaris against a fixed wrist [35].
  • Chronic repetitive wear and fraying of flexor tendons against the rough surface of the hook is the proposed etiology for closed rupture of the flexor tendon [37].
  • The misleading presentation of a hamate hook stress fracture in a professional bowler is related to a new drilling layout of the bowling ball and technical changes during ball release [29].
  • Technical changes in bowling redistribute micro-constraints on the hook of the hamate using an indirect mechanism of injury through ligaments and flexor tendons [29].

Classification

Epidemiology and Mechanism

  • Fractures of the hook of the hamate are rare injuries [7].
  • Hamate hook fracture represents 2% of carpal bone fractures [48].
  • The incidence of acute hook of hamate fracture in association with high-energy distal radius fractures is 2.7% [18].
  • Combined intraarticular fracture of the body and hook of hamate is an extremely rare injury pattern [21].

Diagnostic Challenges

  • Fractures of the hook of the hamate are not seen on standard two or three view wrist examination [26].
  • The similarities between a fracture of the hook of the hamate and other conditions that cause ulnar wrist pain can lead to failure of clinical diagnosis [17].
  • Combined intraarticular fracture of the body and hook of hamate requires a high index of suspicion for diagnosis [21].

Imaging and Physical Examination

  • The carpal tunnel radiographic view should be considered in addition to routine radiographic views for patients with a possible hook of the hamate fracture [6].
  • 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 [25].
  • A CT scan has 95% specificity and 95% accuracy in diagnosing hamulus fractures [33].
  • Pain is provoked by resistive extension of the ring and middle finger PIP joints in the diagnosis of hamulus fracture or nonunion [33].

Clinical Presentation

Diagnostic Challenges and Rarity

  • These fractures are not seen on standard two or three view wrist examination [26].
  • Combined intraarticular fracture of the body and hook of hamate is an extremely rare injury pattern requiring a high index of suspicion for diagnosis [21].
  • Hook of hamate fractures present with similarities to other conditions that cause ulnar wrist pain [17].

Physical Examination Findings

  • Volar tenderness on palpation over the hook of hamate was present in 100% of cases in a study of acute hook of hamate fractures [67].
  • The pull test was painful for all patients in a study of acute hook of hamate fractures [67].
  • Pain over the ulnar-palmar base of the hand should prompt a presumptive diagnosis of fracture of the hook of the hamate until proven otherwise [31].

Imaging and Diagnostic Modalities

  • Lateral trispiral tomography is clearly superior to other diagnostic methods for hamate hook fractures [41].
  • An incidence of 2.7% of acute hook of hamate fracture was identified in association with high-energy distal fractures in patients undergoing CT evaluation of the wrist [18].

Mechanism of Injury

  • Hamate hook stress fractures can result from an indirect mechanism of injury through the ligaments and flexor tendons due to redistributed micro-constraints [29].

Investigations

Clinical Examination

  • Fractures of the hook of the hamate have clinical similarities to other conditions that cause ulnar wrist pain [17].
  • In institutions where this protocol is followed, any patient with pain over the ulnar-palmar base of the hand should have a carpal tunnel view obtained with a presumptive diagnosis of hook of hamate fracture until proven otherwise [31].

Radiography

  • Hook of hamate fractures may be difficult to diagnose on standard x-rays, particularly for non-hand surgeons [1].
  • A specific radiographic view is recommended in addition to standard views for all cases of suspected fractures of the hook of the hamate [8].
  • Fractures of the pisiform and hamulus are not seen on standard two or three view wrist examinations [26].
  • Three variations of the hook of hamate were identified with radiographic evaluation using the carpal tunnel view [80].

Advanced Imaging

  • MRI is the modality of choice for imaging radiographically occult fractures of the hand and wrist [58].
  • Bone marrow edema on MRI may reveal fractures of the carpal bones that are radiographically occult [66].
  • An incidence of 2.7% of acute hook of hamate fracture was identified in association with high-energy distal radius fractures in patients undergoing CT evaluation of the wrist [18].

Treatment

Non-Operative Management

  • Hamate hook fractures diagnosed early may heal with nonoperative management [16].
  • Acute hook of hamate fractures in athletes may be treated with casting [34].
  • Ultrasound treatment might be useful for nonunion of the hook of the hamate caused by repeated stress [46].
  • Low-intensity pulsed ultrasound may be useful in the treatment of ununited fractures of the hook of hamate [50].

Operative Management: Excision

  • Surgical excision as treatment for hook of the hamate fractures is safe and allows a relatively rapid return to play [4].
  • Surgical excision of the hook of the hamate resulted in good postoperative outcomes with a mean follow-up of 6 years [19].
  • 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 [28].
  • MLB players sustaining hook of hamate fractures can reasonably expect to return to their pre-injury performance levels following operative treatment [71].
  • The open carpal tunnel approach is 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 [22].
  • 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 [32].
  • The modified approach through Guyon’s Canal and the proximal ulnar border of the carpal tunnel allows direct visualization of the vital structures most at risk, including the motor branch of the ulnar nerve, unlike blind or unilateral approaches [32].
  • The modified approach through Guyon’s Canal and the proximal ulnar border of the carpal tunnel preserves the nerve supply and blood supply to the hypothenar muscles [32].
  • A lateral approach to the hook of hamate for its fracture is believed to replace the conventional volar approach because of its benefits in terms of time, safety, and simplicity [42].
  • Functional recovery of the hand was satisfactory 2.5 months after surgical resection of the hamate’s hook in a professional bowler with a stress fracture [29].

Operative Management: Fixation

  • 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 [23].
  • In younger patients with nonunion of the hook of the hamate, one should aim for the repair of the nonunion rather than simple excision to preserve grip strength [20].
  • A simplified dorsal approach to fracture of the hamate hook with percutaneous fixation with screws avoids damage to the blood supply of the hamate, surrounding soft tissues, and the ulnar nerve [45].
  • A simplified dorsal approach to fracture of the hamate hook with percutaneous fixation with screws preserves important stabilising ligaments [45].

Outcomes and Biomechanics

  • Patient outcomes were good to excellent regardless of the treatment chosen, with minimal pain and good hand functionality [44].
  • The hamate hook provides some biomechanical advantage for flexor tendon function [43].
  • Cadaveric changes in tendon force after hamate hook excision suggest that power grip may be decreased after hamate hook excision [43].

Diagnostic Challenges

  • A specific radiographic view is recommended in addition to standard ones in all cases of suspected fractures of the hook of the hamate [8].
  • Fractures of the hook of the hamate share similarities with other conditions that cause ulnar wrist pain, leading to failure of clinical diagnosis [17].

Nonunion and Healing Complications

  • Hamate hook fractures that are diagnosed early may heal with nonoperative management [16].
  • Symptomatic partial union of the hook of the hamate fracture in athletes should be managed no differently from a symptomatic nonunion [10].
  • In younger patients with nonunion of the hook of the hamate, repair of the nonunion is preferred over simple excision to preserve grip strength [20].
  • Range of motion and grip strengths were equivalent on the operated and unoperated sides following bone grafting for nonunion [24].

Surgical Complications and Outcomes

  • Surgical excision as treatment for hook of the hamate fractures is safe and allows a relatively rapid return to play in most cases [4].
  • Dorsal percutaneous cannulated mini-screw fixation for non-displaced acute fractures and delayed union of the hamate hook is associated with minimal morbidity and complications [5].
  • Both surgical procedures for hook of hamate fractures appear to yield acceptable outcomes [11].
  • The open carpal tunnel approach for excision of symptomatic ununited hook of hamate fractures is associated with low morbidity [22].
  • The dorsal percutaneous approach provides safe fixation of non-displaced fractures of the hook of hamate [23].
  • Surgical excision for acute and chronic hook of hamate fractures in professional baseball players carries a low risk of minor complications [28].

Associated Injuries and Anatomical Variations

  • The incidence of acute hook of hamate fracture in association with high-energy distal radius fractures is 2.7% in patients undergoing CT evaluation of the wrist [18].
  • Preoperative evaluation of the morphology of the hooks may help predict adverse events in cases of hypoplastic hooks undergoing endoscopic carpal tunnel release [47].

Recovery

Non-Operative Management

Operative Management

  • Dorsal percutaneous cannulated mini-screw fixation treats non-displaced acute fractures and delayed union of the hamate hook with minimal morbidity and complications [5].
  • In younger patients with nonunion of the hook of the hamate, repair of the nonunion rather than simple excision is recommended to preserve grip strength [20].
  • Range of motion and grip strengths were equivalent on the operated and unoperated sides following bone grafting of a hook of hamate nonunion [24].

Key Evidence

  • [Paper] Hook of hamate fractures, with normal standard x-rays, may be difficult to diagnose, especially for a nonhand surgeon. [1] (10.1016/j.hcl.2021.06.013)
  • [L4] Fractures of the hook of the hamate have been infrequently reported in the literature. [2] (10.1016/0020-1383(89)90169-1)
  • [L5] The data support the recommendation that hamate hook fractures can be successfully treated acutely by immediate immobilization. [3] (10.1016/0363-5023(93)90405-r)
  • [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 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. [5] (10.1142/s0218810412970039)
  • [L4] The carpal tunnel radiographic view should be considered in addition to routine radiographic views for patients with a possible hook of the hamate fracture. [6] (10.2519/jospt.2010.0408)
  • [L4] Fractures of the hook of the hamate are rare injuries, with the most usual mechanism being a direct blow to the area of the hook. [7] (10.1016/0266-7681(85)90019-1)
  • [L5] We recommend this view, in addition to the standard ones, in all cases of suspected fractures of the hook of the hamate. [8] (10.1016/s0363-5023(88)80026-1)
  • [L4] The treatment of choice for a symptomatic nonunion, and possibly for an acute fracture, appears to be surgical excision of the hook of the hamate. [9] (10.1016/s0363-5023(88)80107-2)
  • [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. [10] (10.1177/03635465030310010201)
  • [L4] Both surgical procedures appear to yield acceptable outcomes in the treatment of hook of hamate fractures. [11] (10.1016/j.jhsg.2023.11.011)
  • [L4] Hook of hamate regeneration can occur after fracture fragment excision. [12] (10.1016/j.jhsg.2024.08.008)
  • [L4] Early and late surgical excision of the hook of the hamate leads to excellent results with return to preinjury levels of activity. [13] (10.1053/j.otsm.2010.03.003)
  • [L5] The author maintains that repair by open reduction and internal fixation for ununited fracture hook of the hamate is not only feasible but also desirable, both for preservation of grip strength and complete relief of pain. [14] (10.1016/0363-5023(89)90032-4)
  • [L4] Fractures of the hook of the hamate are rare injuries, with the most usual mechanism being a direct blow to the area of the hook. [15] (10.1016/0266-7681_85_90019-1)
  • [L4] Our results show that hamate hook fractures that are diagnosed early may heal with nonoperative management. [16] (10.1016/0363-5023(92)90363-t)
  • [L4] These cases are reported to emphasize the similarities of a fracture of the hook of the hamate to other conditions that cause ulnar wrist pain. [17] (10.1016/s0363-5023(85)80258-6)
  • [L4] The series identified an incidence of 2.7% of acute hook of hamate fracture in association with high-energy distal fractures in patients undergoing CT evaluation of the wrist. [18] (10.1177/1753193411436293)
  • [L4] Surgical excision of the hook of the hamate resulted in good postoperative outcomes with a mean follow-up of 6 years. [19] (10.3109/17453679308993670)
  • [L5] In younger patients with nonunion of the hook of the hamate, the author believes one should aim for the repair of the nonunion rather than simple excision to preserve grip strength. [20] (10.1016/s0363-5023(86)80127-7)
  • [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. [21] (10.1007/s12593-012-0070-2)
  • [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. [22] (10.1016/j.injury.2014.05.008)
  • [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. [23] (10.1177/1753193421991761)
  • [L4] The range of motion and grip strengths were equivalent on the operated and unoperated sides. [24] (10.1016/s0363-5023(89)80008-5)
  • [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. [25] (10.1016/j.jhsa.2010.08.024)
  • [L4] These fractures are not seen on standard two or three view wrist examination. [26] (10.1016/s0736-4679(98)00016-x)
  • [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. [27] (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. [28] (10.1016/j.jhsa.2021.03.015)
  • [L5] [29] (10.1016/j.hansur.2016.06.007)
  • [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. [30] (10.1016/j.hcl.2012.05.013)
  • [L5] The author states that in their institution, anyone with pain over the ulnar-palmar base of the hand should have a carpal tunnel view with the presumptive diagnosis of fracture of the hook of the hamate until proven otherwise. [31] (10.1016/s0363-5023(86)80125-3)
  • [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. [32] (10.1016/j.jhsa.2019.07.015)
  • [L5] [33] (10.1016/j.jhsa.2013.06.004)
  • [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. [34] (10.1016/j.hcl.2012.05.012)
  • [L5] These findings suggest that such an injury results from a sudden, violent contraction of the flexor carpi ulnaris against the fixed wrist. [35] (10.1016/s0266-7681(96)80043-x)
  • [L5] The distal end of the transverse carpal ligament was located 10 mm from the hook of the hamate. [36] (10.1016/0363-5023(94)90073-6)
  • [L4] The proposed etiology of the tendon ruptures is chronic repetitive wear and fraying against the rough surface of the hook. [37] (10.1142/s2424835516720164)
  • [L4] Lateral trispiral tomography is clearly superior to other diagnostic methods for hamate hook fractures. [41] (10.1016/0363-5023(88)90217-1)
  • [L5] The authors believe this lateral approach should replace the conventional volar approach because of its benefits in terms of time, safety, and simplicity. [42] (10.1016/0266-7681(86)90028-8)
  • [L5] The hamate hook provides some biomechanical advantage for flexor tendon function and cadaveric changes in tendon force after its excision suggest that power grip may be decreased after hamate hook excision. [43] (10.1053/jhsu.2003.50005)
  • [L4] Patient outcomes were good to excellent regardless of the treatment chosen, with minimal pain and good hand functionality. [44] (10.1177/1753193417729603)
  • [L4] This minimally invasive technique avoids damage to the blood supply of the hamate, surrounding soft tissues, and the ulnar nerve, while preserving important stabilising ligaments. [45] (10.3109/02844310801956714)
  • [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. [46] (10.1007/s00167-003-0425-0)
  • [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. [47] (10.1016/j.jhsg.2023.12.010)
  • [L5] [48] (10.1097/bth.0b013e31826577f8)
  • [L4] No significant change with finger extension or flexion was noted in either the deep or superficial digital flexor tendons. [49] (10.1142/s2424835519500139)
  • [L5] Based on the results of this case low-intensity pulsed ultrasound may be useful in the treatment of ununited fractures of the hook of hamate. [50] (10.1053/jhsu.2000.jhsu025a0077)
  • [L4] [67] (10.1016/j.jhsa.2019.01.014)
  • [L5] [69] (10.1177/17531934241235803)
  • [L3] MLB players sustaining hook of hamate fractures can reasonably expect to return to their pre-injury performance levels following operative treatment. [71] (10.1123/jsr.2017-0071)
  • [L5] [72] (10.1177/17531934241304249)
  • [L4] Three variations of the hook of hamate were identified with radiographic evaluation using the carpal tunnel view. [80] (10.1016/j.jhsa.2005.05.018)

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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.

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