Hamate Hook Fracture with Flexor Tendon Ruptures as a Golf Injury

Jong-Min Kim; Jung Wook Paeng; Myung Jae Yoo; Sang-Hyun Woo

doi:10.12790/jkssh.2016.21.1.16

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Kim, Paeng, Yoo, and Woo: Hamate Hook Fracture with Flexor Tendon Ruptures as a Golf Injury

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(1):16-22.

Published online: 11 March 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.1.16

Hamate Hook Fracture with Flexor Tendon Ruptures as a Golf Injury

Jong-Min Kim, Jung Wook Paeng, Myung Jae Yoo, 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, E-mail: handwoo@hotmail.com

Received 17 November 20152 February 2016 Accepted 5 February 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

REFERENCES

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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.

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.

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.

Table 1.

Demographics of the Patients with hamate hook fracture or flexor tendon rupture

Patient	Age (yr)/ Sex	Handicap	Time from Injury to surgery (mo)	Hamate fracture	Tendon rupture (involved tendon)	Reconstruction	Final results^*
1	46/male	80	7	Yes	No	_-	_-
2	49/male	80	5	Yes	No	-	-
3	42/male	90	4	Yes	No	_-	_-
4	49/male	90	4	Yes	No	-	-
5	52/male	80	3	Yes	No	_-	_-
6	51/male	80	3	No	Yes (5th FDP)	4th FDS →5th FDP	Good
7	38/male	90	1	No	Yes (5th FDP)	4th FDS →5th FDP	Good
8	52/male	80	3	No	Yes (5th FDP)	4th FDS →5th FDP	Good
9	47/male	90	4	No	Yes (5th FDP)	4th FDS →5th FDP	Excellent
10	46/male	80	3	Yes	Yes (5th FDP)	3rd FDS →5th FDP	Excellent
11	54/male	Unknown	6	Yes	Yes (5th FDP)	4th FDS →5th FDP	Fair
12	45/male	80	3	Yes	Yes (4th FDP^†, 5th FDP)	4th FDS →5th FDP	Good
13	54/male	100	2	Yes	Yes (4th FDS^†, 5th FDP)	4th FDS →5th FDP	Good
14	55/male	80	5	Yes	Yes (4th FDP^†, 5th FDP)	4th FDS →5th FDP	Fair
15	62/male	70	1	Yes	Yes (4th FDP^†, 5th FDP)	3rd FDS →5th FDP	Rerupture
16	59/male	80	7	Yes	Yes (4th FDS^†, 5th FDP^f)	Debridement
Mean	50	83	3.8

FDP, flexor digitorum profundus.

^* Assessed by American Society for Surgery of the Hand (ASSH) based on total active motion¹⁴;

^† Partial tendon injury was treated by debridement.

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)

Assessment	Total active motion (% of corresponding contralateral digit)
Excellent	257°< (100)
Good	195°–257° (75–99)
Fair	130°–194° (50–74)
Poor	<129° (50)

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