Our results suggest that PHILOS is an effective system for providing fracture stabilisation to bony union but awareness of potential hardware complications is essential.

Fractures of the hook of the hamate have rarely been reported. They have usually resulted from blunt trauma or a sharp strike against the hamate hook while swinging a golf club, baseball bat, or tennis racquet. Patients present with acute onset of pain localised over the ulnar aspect of the wrist and reduction in grip strength. In the case reported here, the patient complained of gradual onset of pain on the ulnar aspect of the wrist after altering his grip for serving in tennis. Once the diagnosis was made, the fracture was treated conservatively and the patient made a complete recovery.T he purpose of this paper is to (a) report that the hook of the hamate may be fractured as a result of stress from repetitive microtrauma and (b) review the literature. CASE REPORTA 33 year old, right handed, recreational athlete presented with a two week history of pain on the ulnar side of his right wrist. The pain gradually began while he was playing tennis, starting four weeks after he had changed his style of serving and consequently his grip on the handle of his racquet. He did not remember any incident when the butt of the handle hit his wrist forcefully and he had no other history of injury. There was tenderness over the fourth carpometacarpal joint, mainly on the dorsal side, and his grasp was weakened. There was no localised swelling, and pinch strength was normal. Routine anteroposterior and lateral radiographs and an ultrasound scan were normal. He was initially treated with a steroid injection over the fourth and fifth extensor tendons and a wrist brace. He had no relief of symptoms and was referred to us five weeks later.Clinical examination showed tenderness over the dorsal aspect of the fourth and fifth carpometacarpal joints and severe tenderness over the canal of Guyon. Radiographs, including a carpal tunnel view for a suspected hook of the hamate fracture, were inconclusive. A bone scintigram showed a hot spot at the ulnar aspect of the distal carpus. A magnetic resonance imaging (MRI) scan excluded avascular necrosis of the hook of the hamate and showed marrow oedema suggestive of a fracture, but no fracture line was delineated (fig 1). A high density computed tomography scan confirmed the diagnosis of fracture of the hook of the hamate (fig 2).The patient was treated with a brace for three weeks and a plaster cast including the fourth and fifth fingers, for a further three weeks, because of a mild recurrence on resuming work. Since then, the wrist has become completely pain free and has regained full function. The patient has returned to playing tennis at his former level and is symptom free one year after the onset of symptoms. DISCUSSIONA review of the literature shows that fractures of the hook of the hamate have been rarely reported. A high index of suspicion is required to establish the diagnosis. It is easily overlooked and dismissed as a wrist sprain. The fracture is usually associated with trauma, usually the result of a fall on the dorsiflexed hand, 1 2 direct impact on the palm causing sudden forc...

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