J Korean Orthop Assoc.  2008 Aug;43(4):458-464. 10.4055/jkoa.2008.43.4.458.

Fragment Excision for the Treatment of Hamate Hook Nonunion

• Kang HJ
• Jung SH
• Jung JY
• Park KH
• Hahn SB

• KMID: 1480406
• DOI: http://doi.org/10.4055/jkoa.2008.43.4.458

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 postoperatively.
RESULTS
The initial symptoms were pain (3 cases), tingling sensation (3 cases), 5th DIP joint flexion LOM (2 cases), and pain and accompanying LOM in 5th 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 5th 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 4th and 5th fingers.
CONCLUSION
Hamate hook excision after nonunion showed excellent clinical results in one year postoperative follow-up.

Keyword

Hamate hook fracture; Nonunion; Fragment excision

MeSH Terms

Carpal Tunnel Syndrome
Formycins
Hand Strength
Humans
Joints
Ligaments
Range of Motion, Articular
Retrospective Studies
Ribonucleotides
Rupture
Sensation
Sports
Tendon Transfer
Formycins
Ribonucleotides

Figure

• 

  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.

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