Abbreviations CT, computed tomography; HH, hook of the hamate Case ReportA 54-year-old right-handed woman was referred by a hand surgeon because of local pain in the ulnar aspect of the right wrist radiating down into the fourth and fifth fingers. She had a fall on both wrists 4 months previously. Standard anteroposterior and lateral radiographs obtained after the accident showed a displaced fracture of the left distal radius but no traumatic lesions of the right wrist. She was successfully treated by osteosynthesis of the left radius. After 4 months, because of persistent pain in the right wrist, she consulted a hand surgeon, who asked for an sonographic examination to rule out tenosynovitis of the flexor tendons.Clinical examination showed a normal appearance of the hand and wrist without local swelling or redness. Case Report ractures of the hook of the hamate (HH) account for approximately 2% of wrist fractures and can follow local acute trauma or chronic overuse in racket, club, and bat sports, mainly tennis, golf, and baseball. Because of limitations in detecting them on standard radiographs, they can go easily undiagnosed. When unrecognized, they can evolve into painful nonunions and can be followed by local complications such as tenosynovitis and tendon rupture of the flexor tendons of the fourth and fifth fingers as well as impingement on the ulnar nerve and artery. Because of recent technical improvements, sonography is nowadays considered a useful imaging technique in the assessment of musculoskeletal disorders, including traumatic soft tissues lesions. In addition, fractures that are difficult to diagnose by standard radiography can be detected by sonography because of its tomographic capabilities. We report a case of a fracture of the HH diagnosed by sonography that was undetected on standard radiographs.

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