Complications after Nonoperative Management of Hamate Fractures

Abstract

Background: Hamate fractures are an infrequent injury and are often missed or have a delayed diagnosis with potential for significant patient morbidity. There is a relative paucity in the literature involving large population studies of hamate fractures and subsequent complications. Gaining a better understanding of complications associated with nonoperative management will help guide the decision for operative intervention. Methods: The PearlDiver patient records database was used to query for patients who sustained a hamate fracture using ICD-9 and ICD-10 codes. Postinjury complications within 1 year of diagnosis were assessed using ICD-9 and ICD-10 codes for diagnoses of complications. Results: A total of 1120 patients who sustained a hamate hook or body fracture met inclusion and exclusion criteria and were included in the study. Patients who were managed nonoperatively showed a nonunion rate of 2%, ulnar neuropathy rate of 1.7%, and tendon rupture rate of 0.2%. In a subanalysis using only ICD-10 codes to distinguish between hook and body fractures, hook fractures demonstrated a nonunion rate of 2.2%, ulnar neuropathy rate of 2.7%, and tendon rupture rate of 0%, while body fractures had a nonunion rate of 1.2%, ulnar neuropathy rate of 1%, and tendon rupture rate of 0%. Conclusion: The current study shows very low rates of nonunion, ulnar neuropathy and tendon rupture after nonoperative management of hamate fractures.

Study of Hamate Fractures in a Single Tertiary Hands Unit: A Retrospective Cohort Study and Literature Review

“… 7 , 12 , 17 The published literature has shown very low rates of these complications. 18 Such complications are exacerbated by delayed diagnosis or noncompliance. 7 For our cohort, the goal of surgery was to improve the alignment, especially in subluxations, to reduce the risk of future arthritis.…”

“…Arthritis is a potential long-term complication following hamate fracture. 18 The propensity for hamate fracture patients to develop arthritis is not well described given the lack of long-term cohort analyses. We suspect there is a reasonably high incidence of carpometacarpal joint osteoarthritis after hamate fracture, but that it is well tolerated by most patients, who therefore rarely present.…”