Journal List > J Korean Soc Surg Hand > v.21(1) > 1106530

J Korean Soc Surg Hand. 2016 Mar;21(1):16-22. Korean.
Published online March 31, 2016.  https://doi.org/10.12790/jkssh.2016.21.1.16
Copyright © 2016. The Korean Society for Surgery of the Hand
Hamate Hook Fracture with Flexor Tendon Ruptures as a Golf Injury
Jong-Min Kim, Jung Wook Paeng, Myung Jae Yoo and Sang-Hyun Woo
W Institute for Hand and Reconstructive Microsurgery, W Hospital, Daegu, Korea.

Correspondence to: Sang-Hyun Woo. W Institute for Hand and Reconstructive Microsurgery, W Hospital, 1632 Dalgubeol-daero, Dalseo-gu, Daegu 42642, Korea. TEL: +82-53-550-5000, FAX: +82-53-550-4000, Email: handwoo@hotmail.com
Received November 17, 2015; Revised February 02, 2016; Accepted February 05, 2016.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Purpose

We report surgical results and the relationship between hamate hook fracture and flexor tendon rupture occurred during excessive golf practice or rounding.

Methods

The 16 cases of patients with fracture of hamate hook or flexor tendon injury caused by golf swing were examined retrospectively. Hamate hook excision were underwent in fracture alone, flexor tendon reconstruction with tendon transfer of 3rd or 4th flexor digitorum sublimus (FDS) were done in the flexor tendon rupture. Postoperative results were evaluated by means of American Society for Surgery of the Hand (ASSH) to compare total range of motion and the grip strength.

Results

The fracture gap was not far apart completely in computed tomography (CT) of hamate fracture alone cases. If the flexor tendon rupture with the fracture, the gap in CT was far apart completely. After flexor tendon transfer surgery, two cases were excellent, five cases were good, two cases were fair in ASSH assessment. One case was re-rupture. Grip strength as compared with the normal side was observed for the mean grip strength of 82% recovery.

Conclusion

The instability of the hamate hook fracture affected to flexor tendon rupture rather than location of the fracture. Hamate hook excision and tendon transfer with FDS can be a good treatment option.

Keywords: Hamate hook; Flexor tendon; Fracture; Rupture; Tendon transfer; Golf

Figures


Fig. 1
(A) The zigzag incision on the palm to avoid median and ulnar nerve injury and to find out proximal stump of ruptured flexor tendon as well as hamate hook fracture. (B) Fracture fragment was excised from the hamate. (C) View of ruptured 5th flexor digitorum profundus (FDP). (D) The periosteum over the hook site was repaired to construct a smooth tunnel floor over the base of the excised hook. (E) 1 cm-transverse incision was made over volar digitopalmar crease and 4th flexor digitorum sublimus (FDS) was divided. (F) Then 4th FDS was sutured to the distal 5th FDP using a Pulvertaft interweaving technique.
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Fig. 2
Comparative computed tomography scan images of (A). Hamate hook fracture only and (B). Hamate hook fracture with flexor tendon rupture. Note the gap of fracture completely in B.
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Fig. 3
Preoperative and postoperative clinical photographs. (A) Preoperative photographs showed inability to flex small finger. (B) Postoperative photographs showed nearly full flexion of the small finger.
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Tables


Table 1
Demographics of the Patients with hamate hook fracture or flexor tendon rupture
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Table 2
American Society for Surgery of the Hand grading for flexor tendon assessment (sum of the degrees of active metatarsophalangeal, proximal interphalangeal, distal interphalangeal joint flexion)
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