Fractures of the Hamate Bone: A Review of Clinical Presentation, Diagnosis and Management in the United Kingdom

Abstract

Injury to the hamate can result in significant functional impairment and a negative impact on quality of life. These injuries, in general, occur very infrequently, and in the setting of an increasingly ageing population and more patients presenting post falls, clinicians are at risk of either misdiagnosing or failing to diagnose patients who sustain hamate fractures. This review finds that hamate fractures can occur through acute trauma or chronic repetitive stress. These injuries are often missed resulting in a delay to management. Common presenting features of hamate fractures include ulnar-sided palmar tenderness and paraesthesia in the ulnar nerve distribution, loss of grip strength and pain on swinging a gripped object. In examination, the hamate “pull test” is a highly sensitive test for hamate fractures. CT scan of the carpal bones is shown to be the gold standard investigation for the diagnosis of such injuries. Initial management of hamate fractures in the United Kingdom is in line with the National Institute of Health and Care Excellence (NICE) guidelines that involves immobilisation with a suitable splint and sling for comfort, adequate analgesia, rest and elevation. Specific management of hamate fractures is divided into conservative and surgical options; however, this review identifies the need for further research into which form of management is superior.