Artikel
A Weak Part Of The Strong Hand: Hook Of Hamate Fractures
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Autoren
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Claus M. Kullen
- Institute of Diagnostic and Interventional Radiology, Neuroradiology, Westkuestenklinikum, Heide, Germany
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Julian Ramin Andresen
- Sigmund-Freud-University, Medical School, Wien, Austria
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Sebastian Radmer
- Centre for Orthopaedics, Berlin, Germany
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Reimer Andresen
- Institute of Diagnostic and Interventional Radiology, Neuroradiology, Westkuestenklinikum, Heide, Germany
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Oliver Scheufler
- Aare Klinik, Aesthetic and Plastic Surgery, Bern, Switzerland
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Some of the popular sports predispose to a specific injury: the hamate hook fracture which accounts for about 2-4% of all wrist fractures. They are not readily observed on conventional radiographic imaging and hence remain untreated or treatment is delayed. The aim was to identify sport activities that are associated with an increased risk of hamate hook fractures and to present an update on the current state of diagnostic and treatment options for these fractures.
Methods: Selective literature search was performed in PubMed and Google Scholar using the terms "hamulus ossis hamati fracture", "hook of hamate fracture", "sport injuries", "tennis", "rugby", "bouldering", and "golf". Due to the number of hits, 228 relevant original papers, case series, case reports and mainly meta-analyses, and review articles published until 2018 were included.
All relevant articles were obtained and evaluated for key points, including the mechanism of trauma, injury patterns, radiological imaging, treatment, and outcome.
Results and Conclusions: Due to popularity of classic sports, such as tennis or golf in an aging society, the risk of hamate hook fractures rises. It appears also that younger athletes performing sports such as climbing, bouldering, baseball or underwater rugby are associated with a higher injury rate to the hamate hook.
These can be caused by direct or indirect forces acting on the hamulus and the surrounding carpal ligamental structures and can occur as a single force overload or after repetitive trauma. In conventional radiographs, hook fractures are often missed on standard projections. The carpal tunnel view and special 45 degree oblique projection significantly increase the sensitivity. However, CT provides the most reliable imaging modality with a sensitivity of almost 100%. MRI offers the advantage of simultaneous detection of concomitant soft tissue injuries and microtraumas.
Non-displaced fractures near the base of the hook can be immobilized in a lower arm cast. Dislocated basal fractures and those in the middle third should be treated by internal fixation through an open or percutaneous access. Consolidation of distal fractures is unreliable with either conservative treatment or osteosynthesis. Therefore fragment excision is recommended. Overall, the results of conservative treatment are disappointing with a high rate of non-union.
In conclusion the hamate hook fracture is more relevant than you might think.
