Treatment of Fracture of Hook of the Hamate in Baseball Players
2012; Elsevier BV; Volume: 28; Issue: 3 Linguagem: Inglês
10.1016/j.hcl.2012.05.013
ISSN1558-1969
Autores Tópico(s)Orthopedic Surgery and Rehabilitation
Resumoli ni cs .c om Fractures of the hook of the hamate in baseball players usually result from a forceful swing of the bat and rarely from a slide into a base or by hitting a wall. The players usually present with pain over the ulnar side of the hand. Examination consists of compressing the hook of the hamate with the body of the hamate on the dorsum of the hand, and this reproduces the patient’s pain. Occasionally, players can experience a discomfort with flexion extension of the ulnar digits because of bleeding and irritation of the flexor tendons as they course radial to the hook of the hamate. One thing that has to be ruled out with this injury is thrombosis of the ulnar artery. This can usually be evaluated by a simple Allen test. I usually obtain anteroposterior lateral and oblique images of the wrist in addition to a carpal tunnel view. If the carpal tunnel view does not clearly show the fracture of the hook of the hamate, we proceed to getting a computed tomographic scan, which is probably the gold standard. I feel that surgical excision is the treatment of choice for fractures of the hook of the hamate in any athlete. There have been few reports of attempted open reduction internal fixation hook of the hamate, but I think the incidence of nonunion in my mind precludes the use of this technique. The surgical procedure is performed through a 1-in incision directly over the hook of the hamate. Care is taken to preserve and protect the ulnar neurovascular bundle. Sharp dissection is used to expose the hook with retractors placed to protect the flexor tendons and also the ulnar neurovascular bundle. Extreme caremust be taken when dissecting the distal ulnar portion of the hamate hook
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