gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016)

25.10. - 28.10.2016, Berlin

Moving Harder Than the Hamate Tolerates: Hamate Fractures in Climbing and Bouldering

Meeting Abstract

  • presenting/speaker Christoph Lutter - Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Germany
  • Andreas Schweizer - Dept. of Hand Surgery, University of Zurich, Switzerland, Zurich, Switzerland
  • Thomas Hochholzer - Private Hospital Hochrum/Innsbruck, Innsbruck, Austria
  • Thomas Bayer - Dept. of Radiology, Friedrich Alexander University, Erlangen, Erlangen, Germany
  • Volker Schoeffl - Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2016). Berlin, 25.-28.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocPO22-445

doi: 10.3205/16dkou684, urn:nbn:de:0183-16dkou6842

Veröffentlicht: 10. Oktober 2016

© 2016 Lutter et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objectives: Comprising two to four percent of all carpal fractures, hamate hook fractures are rare injuries. Rock climbing athletes seem to be affected more frequently than others as they strain their passive and active anatomical structures of their hands and fingers to maximum during high-end training or competing (Table 1). This stress is transmitted to the hook of the hamate by tightened flexor tendons, which create a high contact pressure to the ulnar margin of the carpal tunnel. Injuries of the hamate hook, caused by other than external impact but by contact pressure of the anatomical structures, are rare and occur during climbing or bouldering nearly exclusively.

Methods: We now diagnosed 12 athletes with diffuse pain in the wrist joint, which occurred during or after climbing or bouldering (a power-intensive form of climbing performed without ropes) (Figure 1). Radiographs and/or CT revealed fractures in the hamate bones in most of the patients; as other diagnoses such as inflammation, tumor or injuries could be largely excluded, we classified those fractures of hamate as due to overload. Hamate fractures were grouped following the Milch's classification separating fractures in two main groups (Type I fractures affect the hamate hook, type II fractures are located within the body of the hamate). Hamate hook fractures were sub-classified in Type I(I) fractures (avulsion fractures at the tip of the hook), type I(II) fractures (middle part of the hook) and type I(III) fractures (base of the hook).

The therapy consisted of consequent stress reduction and a break from sporty activity; in three patients, surgical treatment was necessary after conservative therapy showed no improvement.

Results and Conclusion: Follow-up investigations showed satisfying healing tendencies and all athletes were free of symptoms after a time span of 10.7 ± 5.1 (6 - 24) weeks. Resection of the hamate hook was necessary in three patients. They all regained their pre-injury climbing level (Table 1).

The reason why this kind of injury is seen more and more frequently nowadays is probably the rising number of athletes who are able to climb on the upper end of climbing grades (level of difficulty). Fractures of hamate bones are almost always hard to diagnose in X-ray. Therefore a CT-scan or MRI should be considered in rock climbing athletes with pressure pain over the hamate after high intense training or competing. If no fracture can be seen in CT but clinical examination clearly shows pathology of the hamate hook it can be interpreted as "insertions-ligamentopathy" of the hamate's hook-tip. Consolidation of the fracture site should be ensured and documented by CT, as little finger tendons can be frayed by the fracture site, which would ultimately lead to a rupture of the tendon. We recommend conservative therapy or ORIF to avoid fragment resection in type I fractures, especially in type I(II) or type I(III) cases where relatively large fragments are detected via CT.