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.
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:
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 ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



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


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.


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.


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


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.
Click for larger image

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.
Click for larger image

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.
Click for larger image


Table 1
Demographics of the Patients with hamate hook fracture or flexor tendon rupture
Click for larger image

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)
Click for larger image

1. Takami H, Takahashi S, Ando M. Rupture of flexor tendon associated with previous fracture of the hook of the hamate. Hand 1983;15:73–76.
2. Parker RD, Berkowitz MS, Brahms MA, Bohl WR. Hook of the hamate fractures in athletes. Am J Sports Med 1986;14:517–523.
3. Hartford JM, Murphy JM. Flexor digitorum profundus rupture of the small finger secondary to nonunion of the hook of hamate: a case report. J Hand Surg Am 1996;21:621–623.
4. Crosby EB, Linscheid RL. Rupture of the flexor profundus tendon of the ring finger secondary to ancient fracture of the hook of the hamate. Review of the literature and report of two cases. J Bone Joint Surg Am 1974;56:1076–1078.
5. Torisu T. Fracture of the hook of the hamate by a golf-swing. Clin Orthop Relat Res 1972;83:91–94.
6. Nisenfield FG, Neviaser RJ. Fracture of the hook of the hamate: a diagnosis easily missed. J Trauma 1974;14:612–616.
7. Bishop AT, Beckenbaugh RD. Fracture of the hamate hook. J Hand Surg Am 1988;13:135–139.
8. 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.
9. Carter PR, Eaton RG, Littler JW. Ununited fracture of the hook of the hamate. J Bone Joint Surg Am 1977;59:583–588.
10. Milek MA, Boulas HJ. Flexor tendon ruptures secondary to hamate hook fractures. J Hand Surg Am 1990;15:740–744.
11. 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.
12. Yamazaki H, Kato H, Nakatsuchi Y, Murakami N, Hata Y. Closed rupture of the flexor tendons of the little finger secondary to non-union of fractures of the hook of the hamate. J Hand Surg Br 2006;31:337–341.
13. Imbriglia JE, Goldstein SA. Intratendinous ruptures of the flexor digitorum profundus tendon of the small finger. J Hand Surg Am 1987;12:985–991.
14. Riaz M, Hill C, Khan K, Small JO. Long term outcome of early active mobilization following flexor tendon repair in zone 2. J Hand Surg Br 1999;24:157–160.
15. Marks MR, Gunther SF. Efficacy of cortisone injection in treatment of trigger fingers and thumbs. J Hand Surg Am 1989;14:722–727.
16. Murray PM, Cooney WP. Golf-induced injuries of the wrist. Clin Sports Med 1996;15:85–109.
17. Mallon B. Biomechanics of the golf swing in players with pathologic conditions of the forearm, wrist and hand. Am J Sports Med 1992;20:99.
18. Palmer AK, Werner FW, Murphy D, Glisson R. Functional wrist motion: a biomechanical study. J Hand Surg Am 1985;10:39–46.
19. 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.
20. Xiong G. Hook of hamate fractures: location and tendon rupture. J Hand Surg Am 2014;39:175–176.
21. Brand PW. In: Clinical mechanics of the hand. St. Louis: Mosby; 1985.
22. Jeong SH, Gu JH, Han SK, Kim WK. Two-staged tendon reconstruction in flexor tendon ruptures secondary to fracture of the hamate hook. Ann Plast Surg 2012;69:157–160.