Hook of Hamate Fractures

Hook of Hamate Regrowth After Surgical Excision: A Report of Two Cases

Two high-level baseball players sustained a hook of hamate fracture while batting and were treated with excision of the fragment. Both players returned to play, and both had repeat fractures through a regenerated hook. This phenomenon of hook of hamate regeneration has not been well described in the literature. In conclusion, hook of hamate regeneration can occur after fracture fragment excision. The incidence and risk of this sequela as well as its association with surgical technique is uncertain.

The aetiology of fracture and nonunion in the hook of the hamate

Fractures of the hook of the hamate are traditionally thought to be caused by direct trauma. A review of the anatomy and function of the hamate hook suggests that 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. 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. These changes are likely to predispose to stress fracture and nonunion in repetitive gripping activities and are consistent with radiological findings.

Return to Play After Hook of Hamate Fracture: A Systematic Review and Meta-Analysis

In athletes, a hook of hamate fracture is concerning in terms of time to return to sport and effect on performance upon return. This study aims to analyze the treatment of hook of hamate fractures in athletes to determine their rates of return to play, timelines of recovery, and performance level upon return to play. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform this analysis. The PubMed database was queried to perform the literature search. Data were pooled and analyzed. P values <.05 were considered significant. Data were analyzed using the Comprehensive Meta-Analysis software to determine heterogeneity. Twenty studies with 823 patients sustaining hook of hamate fractures that reported any competitive level of play were included in the analysis. Of the 823 patients, 778 (94.5%) were able to return to play with 91.2% (506/555) of patients demonstrating similar or improved performance. The mean time to return to play was 45 days (range: 21-168 days). Treatment included surgical excision for 787 patients (95.6%), open reduction and internal fixation for 18 patients (2.2%), stress reduction/casting for 13 patients (1.6%), and loss to follow-up or surgery refusal for 5 patients (0.6%). A very high number of athletes return to play following a hook of hamate fracture at the same or improved level of performance. In our study, the majority of injuries were treated with surgical excision of the fractured hook of hamate fragment. Most athletes returned to their sport at an average of 45 days.

Excision of the hook of hamate in athletes using the carpal tunnel approach

BACKGROUND

Hook of the hamate fractures can be managed conservatively or fixed using a screw, but excision is recommended for prompt return to activities. Although various approaches have been described, there is no gold standard. Herein, the authors have described their clinical experiences in excising the hook of the hamate using the carpal tunnel approach, in athletes.

METHODS

A total of 36 athletes underwent excision of the hamate hook using the carpal tunnel approach. The mean age of the patients was 23 years, and most of them were baseball players (n = 31).

RESULTS

The mean operation time was 33 min. None of the patients presented with any complications aside from transient pillar pain in five cases. All of them returned to their sports activities within an average of 27 days.

CONCLUSIONS

In our study, excision of the hook of the hamate was performed safely via the carpal tunnel. The carpal tunnel approach reportedly provides superior benefits over other approaches.

Grip strength after hamate hook excision and reconstruction surgery: A biomechanical cadaveric study

Fractures of the hamate hook are common among professional athletes. The recommended treatment for this is hamate hook excision. The purpose of this study is to evaluate the hand grip strength after hamate hook resection at different levels. Six cadaver forearm flexor digitorum profundus tendons were loaded with 5- to 15-kilograms force and grip strength was subsequently measured. The same measurements were performed in five hamate hook conditions: normal, one-third, two-thirds, total hamate excision, and after perihamate ligament reconstruction. Multilevel mixed-effect models were used to calculate the scaling ratios after each surgical intervention and compared them to a normal hamate hook. A 25%, 36%, 47% reduction, and 7% increase (107% of baseline) in grip strength was found after one-third, two-thirds, total bone was resected, and after perihamate ligament reconstruction, respectively. The study shows an association between grip strength reduction and the level of hamate hook resection. Perihamate ligament reconstruction is recommended as it restores grip strength to normal.