Fragment Excision for the Treatment of Hamate Hook Nonunion

Ho-Jung Kang; Sung-Hoon Jung; Joon-Young Jung; Kwang-Hwan Park; Soo-Bong Hahn

doi:10.4055/jkoa.2008.43.4.458

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Kang, Jung, Jung, Park, and Hahn: Fragment Excision for the Treatment of Hamate Hook Nonunion

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(4): 458-464.

Published online: 31 August 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.4.458

Fragment Excision for the Treatment of Hamate Hook Nonunion

Ho-Jung Kang, M.D., Sung-Hoon Jung, M.D., Joon-Young Jung, M.D., Kwang-Hwan Park, M.D., Soo-Bong Hahn, M.D.

Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.

Address reprint requests to Sung-Hoon Jung, M.D. Department of Orthopaedic Surgery, Yongdong Severance Hospital, 146-92, Dogok-dong, Kangnam-gu, Seoul 135-720, Korea. Tel: +82.2-2019-3410, Fax: +82.2-573-5393, doctors@hanmail.net

Abstract

Purpose

To evaluate the treatment results of fragment excision of the hamate hook nonunion.

Materials and Methods

Nine patients operated for hamate hook nonunion were reviewed retrospectively, and were clinically assessed for pain, range of motion, tingling sensation, and grip strength post-operatively.

Results

The initial symptoms were pain (3 cases), tingling sensation (3 cases), 5^th DIP joint flexion LOM (2 cases), and pain and accompanying LOM in 5^th DIP joint flexion (1 case). The causes of injuries seemed to be mainly associated with sports activities. Time from initial symptom to diagnosis was averaged 15 months (2 months-5 years), and confirmative image was plain x-ray (one case), carpal tunnel view (six cases), and CT scan (two cases). All patients underwent fragment excision, and in three patients with accompanying carpal tunnel syndrome, transverse carpal ligament release was performed accordingly. In three other patients complicated with 5^th FDP rupture, tenorrhaphy was performed in two cases, and tendon transfer was performed in the other case. Eight patients showed excellent clinical results one year postoperatively, but one patient complained of transient tingling sensation on the 4^th and 5^th fingers.

Conclusion

Hamate hook excision after nonunion showed excellent clinical results in one year postoperative follow-up.

Keywords: Hamate hook fracture, Nonunion, Fragment excision

Figures and Tables

Fig. 1

A 46-year old man presented with long lasting palmar pain on left hand since having played golf about 11 months ago. (A) On initial carpal tunnel view, nonunion at the base of hamate hook was observed. (B) Hamate hook nonunion was confirmed with CT scan. (C, D) Fragment excision was performed for hamate hook nonunion. (E) Hamate hook excision was confirmed with postoperative carpal tunnel view.

Fig. 2

A 41-year old man presented with flexion LOM on right 5th finger. (A) On 3D CT scan, completely separated hamate hook nonunion was observed. (B) Hamate hook excision was performed. (C) Accompanying 5th FDP rupture was also found with hamate hook nonunion. (D) Tendon transfer to 4th FDP was performed for the ruptured 5th FDP.

Table 1

Summary of Individual Patient Data

^*D, dominant hand; ^†Non-D, non-dominant hand; ^‡TCL, transverse carpal ligament.

References

1. Akahane M, Ono H, Sada M, Saitoh M. Fracture of the hamate hook--diagnosis by the hamate hook lateral view. Hand Surg. 2000. 5:131–137.

2. Baird DB, Friedenberg ZB. Delayed ulnar-nerve palsy following a fracture of the hamate. J Bone Joint Surg Am. 1968. 50:570–572.

3. Bishop AT, Beckenbaugh RD. Fracture of the hamate hook. J Hand Surg Am. 1988. 13:135–139.

4. Boulas HJ, Milek MA. Hook of hamate fractures. Diagnosis, treatment, and complications. Orthop Rev. 1990. 19:518–529.

5. Carter PR, Eaton RG, Littler JW. Ununited fracture of the hook of the hamate. J Bone Joint Surg Am. 1977. 59:583–588.

6. David TS, Zemel NP, Mathews PV. Symptomatic, partial union of the hook of the hamate fracture in athletes. Am J Sports Med. 2003. 31:106–111.

7. Failla JM. Osteonecrosis associated with nonunion of the hook of the hemate. Orthopedics. 1993. 16:217–218.

8. Failla JM. Hook of hamate vascularity: vulnerability to osteonecrosis and nonunion. J Hand Surg Am. 1993. 18:1075–1079.

9. Foucher G, Schuind F, Merle M, Brnelli F. Fractures of the hook of the hamate. J Hand Surg Br. 1985. 10:205–210.

10. Fujioka H, Juichi T, Yoshiya S, et al. Ultrasound treatment of nonunion of the hook of the hamate in sports activities. Knee Surg Sports Traumatol Arthrosec. 2004. 12:162–164.

11. Futami T, Aoki H, Tsukamoto Y. Fractures of the hook of the hamate in athletes. 8 cases followed for 6 years. Acta Orthop Sacnd. 1993. 64:469–471.

12. Guha AR, Marynissen H. Stress fracture of the hook of the hamate. Br J Sports Med. 2002. 36:224–225.

13. Hart VL, Gaynor V. Roentgenographic study of the carpal canal. J Bone Joint Surg Am. 1941. 23:382–383.

14. Kato H, Nakamura R, Horii E, Nakao E, Yajima H. Diagnostic imaging for fracture of the hook of the hamate. Hand Surg. 2000. 5:19–24.

15. Manske PR. Fracture of the hook of the hamate presenting as carpal tunnel syndrome. Hand. 1978. 10:181–183.

16. Milek MA, Boulas HJ. Flexor tendon ruptures secondary to hamate hook fractures. J Hand Surg Am. 1990. 15:740–744.

17. Minami A, Ogino T, Usui M, Ishii S. Finger tendon rupture secondary to fracture of the hamate. A case report. Acta Orthop Scand. 1985. 56:96–97.

18. Murray WT, Meuller PR, Rosenthal DI, Janernek RR. Fracture of the hook of the hamate. AJR Am J Roentgenol. 1979. 133:899–903.

19. Papilion JD, Dupuy TE, Aulicino PL, Bergfield TG, Gwathmey FW. Radiographic evaluation of the hook of the hamate: a new technique. J Hand Surg Am. 1988. 13:437–439.

20. Parker RD, Berkowitz MS, Brahms MA, Bohl WR. Hook of hamate fractures in athletes. Am J Sports Med. 1986. 14:517–523.

21. Scheufler O, Radmer S, Erdmann D, Germann G, Pierer G, Andresen R. Therapeutic alternatives in nonunion of hamate hook fractures: personal experience in 8 patients and review of literature. Ann Plast Surg. 2005. 55:149–154.

22. Stark HH, Chao EK, Zemel NP, Rickard TA, Ashworth CR. Fracture of the hook of the hamate. J Bone Joint Surg Am. 1989. 71:1202–1207.

23. Stark HH, Jobe FW, Boyes JH, Ashworth CR. Fracture of the hook of the hamate in athletes. J Bone Joint Surg Am. 1977. 59:575–582.

24. Watson HK, Rogers WD. Nonunion of the hook of the hamate: an argument for bone grafting the nonunion. J Hand Surg Am. 1989. 14:486–490.

25. Whalen JL, Bishop AT, Linscheid RL. Nonoperative treatment of acute hamate hook fractures. J Hand Surg Am. 1992. 17:507–511.

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