Hamate Hook Non-Union Treated With a Break-Away Screw: A Case Report

Abstract

Hamate hook non-union is a relatively rare, but on the increase. We encountered a 25-year-old male baseball instructor with hamate hook non-union, and treated it with debridement of the fractured region and osteosynthesis using a break-away screw. Splint fixation was applied for three weeks after surgery, and active/passive range of motion exercises were actively performed thereafter. Bone union was noted three months after surgery. Transient ulnar paralysis resolved, and the patient could return to the same sports activity as that before injury six months after surgery. Since break-away screws are capable of loading a strong pressure on the fractured region and these screws can be inserted by preparing only a surgical field for guide wire insertion, requiring no soft tissue dissection to prepare a region for applying fixation materials, break-away screws are useful for the fixation of small bone fragments and osteosynthesis in a deep surgical field.

The Effect of Thumb Immobilization on Fractures of the Hook of the Hamate: A Cadaver Study

“…Carter et al 7 reported 6 base fractures in the 9 patients in his series; all were treated by excision and returned to the preinjury status. More recently, various treatment modalities have been utilized for hamate hook fractures; these include low-intensity pulsed ultrasound, 32,40 use of a breakaway screw, 21 hook plate, 39 or dorsal percutaneous cannulated mini-screw fixation, 35 all with variable success.…”

Radius Styloid Process Fractures Treated with Break-Away Screws: Two Cases Report

“…Maire et al performed 4 courner fusion using break-away screws [7]. We also used this screw for treatment of hamate hook nonunion [8].…”

Hook of the Hamate: The Spectrum of Often Missed Pathologic Findings

“…CT also has the added value of quantifying the degree of displacement, which has implications for clinical decision making [8]. Acute displaced fractures of the hook typically have sharply defined margins on CT images, whereas chronic cases of nonunion present with sclerotic or corticated margins [13, 20]. On CT images, nondisplaced hook of the hamate fracture appears as a sharply defined, thin, lucent line with cortical disruption.…”

“…Surgical fixation has been advocated for restoring normal biomechanics of the wrist. Operative techniques include open palmar screw or K-wire fixation, hook plate fixation, and dorsal percutaneous screw fixation [7, 20, 21, 25]. Low-intensity pulsed ultrasound has been advanced as a noninvasive alternative to surgical intervention in nondisplaced fractures [22, 23].…”