Causes and risk factors
Unlike any other fracture, the major cause of hamate fractures is road accidents or vehicle injury. Fall on wrist causing severe pressure or force on the bone can lead to its breakage. Indirect trauma can also lead to hamate fracture. It can also be associated with muscular or ligamentous injuries of the wrist. Microtrauma resulting due to repeated force or trauma is another contributing factor seen. This is particularly seen in various sports activities like tennis, baseball, golf, and hockey.
Clinical presentation:
Pain is a prominent feature seen. Along with this, swelling and bruising are other complaints. Pain is especially seen at the dorsoulnar side. Swelling is seen at the hypothenar. Weak grip is complained by the patient. Interphalangeal flexion of the 4th and the 5th finger causes pain at the fractured hook of the hamate. A displaced hamate can lead to compression of the ulnar nerve leading to ulnar nerve neuropathy. On examination, tenderness is present.
Investigations:
Considering the symptoms, a local examination is carried out by the orthopedic doctor. There is often a history of injury. A hamate hook pull test is the diagnostic test for hamate fractures. X-ray of the carpal bones in most of the cases can be negative. Fracture of body of hamates is often difficult to diagnose. Hence investigations like CT scan is the most diagnostic imaging test which is done.
Treatment:
Rest, elevation of the arm, and application of ice pack are the essential steps to be implemented. Analgesics or nonsteroidal anti-inflammatory drugs are advised by the orthopedic doctor for relief of the pain. Short arm cast is applied for immobilization for 6-8 weeks. However, it has resulted in poor healing and hence surgical intervention is mostly effective in cases of hamate fractures. Excision is done to remove the fragments or open reduction is done for internal fixation. In cases if ulnar nerve injury is suspected, electrodiagnostic nerve evaluation needs to be done. As recovery starts, certain physiotherapy exercises are advised under the guidelines of a trained physiotherapist.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up with the symptoms. Taking into consideration the symptoms in a holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine which uses herbs and synthetic derivates can also be beneficial in combating the complaints. Certain yoga exercises can also be helpful in strengthening the muscles.
Facts and Figures:
Hamate fractures account for 2% of all fractures.
