Article
High number of hamate hook fractures in underwater rugby players
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Authors
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Peter Kamusella
- Westküstenklinikum Heide, Institut für Diagnostische und Interventionelle Radiologie / Neuroradiologie, Heide, Germany
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Oliver Scheufler
- Praxis füpr Plastische und Ästhetische Chirurgie, Bern, Switzerland
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Lukas Tadda
- Klinikum Bamberg, Innere Medizin/ Pneumologie, Bamberg, Germany
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Sebastian Radmer
- Zentrum für Bewegungsheilkunde, Berlin, Germany
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Sebastian Russo
- Anästhesie, Intensiv- und Rettungsmedizin, Göttingen, Germany
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Reimer Andresen
- Westküstenklinkum Heide, Institut für Diagnostische und Interventionelle Radiologie / Neuroradiologie, Heide, Germany
| Published: | October 24, 2011 |
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Outline
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Objective: Fractures of the hook of the hamate are rare injuries that can manifest in palmo-ulnar pressure pain and paraesthesia in the area supplied by the ulnar nerve.
In underwater rugby players displaying such symptoms, the ensuing diagnostics and therapy were evaluated retrospectively.
Material/Methods: The study was conducted on 17 male, athletic patients in whom a fracture of the hook of the hamate had been confirmed. Radiological imaging included a conventional x-ray in 2 planes and thin-layer computed tomography with multiplanar reconstruction. All patients were immobilised in a plaster splint for at least 6 weeks after diagnosis. If the symptoms persisted, fragment extirpation or osteosynthesis were recommended.
Results: The right hand was affected in all cases, which was also used as the leading hand during games. In the entire patient population, conventional x-rays failed to confirm the fracture (0%). As a result of the persistent symptoms, computed tomography was performed on each patient and confirmed the fracture of the hook of the hamate (100%). Despite recurrent symptoms, periods of 1 week to 4 years elapsed before the correct diagnosis was rendered and therapy given. Among the 17 patients, there were 7/17 distal (~41.2%), 5/17 medial (~29.4%) and 5/17 proximal (~29.4%) fractures of the hook of the hamate, none of them displaying substantial dislocation. Conservative therapy did not achieve freedom from symptoms in any of the patients, 10/17 (58.8%) of them developing a pseudarthrosis, which was confirmed in the CT using image morphology by an increased sclerosis of the adjacent fracture surfaces. Fragment extirpation was performed in these 10/17 patients. In 5/17 patients the fracture was treated with osteosynthesis (ORIF). Despite persistent symptoms, one patient declined surgery. All of the patients who underwent surgery were free of symptoms over the further course, did not experience any loss of strength in the hand and were able to play underwater rugby again.
Conclusion: In underwater rugby, there appears to be a higher incidence of fractures of the hook of the hamate as a result of the specific forces applied to the leading hand. Despite corresponding clinical symptoms, the possibility of a fracture of the hook of the hamate is not considered sufficiently, especially in this sport, and it is often diagnosed very late. If a fracture of the hook of the hamate is suspected, adequate imaging is necessary for early diagnosis and for differentiated planning of therapy.
