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Hook of Hamate Fracture

63 citationsUpdated Oct 2026
Illustration: wrist

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Hook of hamate fractures are rare injuries that have been infrequently reported in the literature [2, 6]. The most usual mechanism is a direct blow to the area of the hook [6]. Diagnosis can be difficult, particularly for non-hand surgeons, when standard x-rays appear normal; therefore, a specific radiographic view is recommended in addition to standard views for all suspected cases [1, 7]. An incidence of 2.7% of acute hook of hamate fracture was identified in association with high-energy distal fractures in patients undergoing CT evaluation of the wrist [17].

Treatment options range from immediate immobilization for acute fractures [3] to dorsal percutaneous cannulated mini-screw fixation, which is a reliable method for non-displaced fractures and delayed unions with minimal morbidity [5, 23]. Surgical excision is the treatment of choice for symptomatic nonunion and possibly for acute fractures [8], particularly in athletes where the incidence of nonunion precludes open reduction internal fixation [30]. Excision is safe, allows a relatively rapid return to play [4], and yields excellent results with return to preinjury activity levels [12, 19, 27]. For younger patients with nonunion, repair by open reduction and internal fixation is feasible and desirable to preserve grip strength [13, 20]. Symptomatic partial union in athletes should be managed as a nonunion with excision and ligament repair [9].

Both surgical procedures yield acceptable outcomes [10]. The open carpal tunnel approach is a successful technique for excision due to its familiarity, ease, visualization, and low morbidity [22]. Excision with smoothing of rough bony surfaces is uniformly recommended when the fracture causes flexor digitorum profundus rupture [18]. Hook of hamate regeneration can occur after fracture fragment excision [11].

Anatomy & Pathophysiology

Bony Anatomy

The hamate consists of the body and the hook (hamulus) [62]. The hook serves as an attachment site for the transverse carpal ligament [62] and provides origin for the flexor digiti minimi and opponens digiti minimi muscles [62]. The distal end of the transverse carpal ligament is located 10 mm from the hook of the hamate [37]. Guyon’s canal is bounded radially by the hook of the hamate and ulnarly by the pisiform [59], containing the ulnar artery and nerve [59].

Vascular Supply

The terminal branches of the radial, ulnar, and anterior interosseous arteries provide extraosseous blood supply to the carpus through three dorsal and three palmar transverse arterial arches with longitudinal connections [65]. The dorsal intercarpal arch is the largest of the dorsal arches and supplies the distal carpal row [65]. The deep palmar arch at the level of the metacarpal bases is consistent and communicates with the dorsal basal metacarpal arch and the palmar metacarpal arteries [65]. Due to its specific vascularity, the hamate hook is vulnerable to osteonecrosis and nonunion [3]. Poor blood supply to the hamate is a main reason for the increased risk of nonunion of the hamate hook [49].

Ligamentous Anatomy

The capitohamate ligament is a thick ligament, 5 × 5 mm in cross section, with extensions to the third or fourth metacarpals [60]. The palmar triquetrohamate ligament and the dorsal triquetrohamate ligament are intrinsic wrist ligaments [60].

Biomechanics and Tendon Function

The hamate hook provides a biomechanical advantage for flexor tendon function [44]. Cadaveric changes in tendon force after hamate hook excision suggest that power grip may be decreased [44]. No significant change with finger extension or flexion was noted in the deep or superficial digital flexor tendons relative to the hook of hamate [50]. The radius of curvature of the little finger flexor tendon is significantly smaller than that of the middle finger flexor tendon in both positions [89].

Pathophysiology and Injury Mechanisms

Hamate hook fracture represents only 2% of carpal bone fractures [49]. Fractures can occur by direct impact applied to the hamate during a fall on the heel of the hand [49] or by microtraumatism in sports requiring repeated use of a racquet or a bat [49]. The growing popularity of golf and other racquet sports has led to an increase in stress fractures of the hamate hook [49]. High-energy single-impact hamate fractures are likely to occur in otherwise healthy bone with no pre-existing stress response [75]. Fracture is more likely as a result of a fatigue response that develops in the hook from repetitive load applied by the adjacent deep flexor tendons [72]. Direct pressure of the tendons on critical local vessels reduces blood flow, leading to mechanical and vascular effects that create pathological osseous change and weakening [72]. These changes predispose to stress fracture and nonunion in repetitive gripping activities [72]. Mobility of the fracture site and delayed diagnosis are main reasons for the increased risk of nonunion of the hamate hook [49]. The proposed etiology of flexor tendon ruptures secondary to sclerosis of the hook is chronic repetitive wear and fraying against the rough surface of the hook [54]. Such injuries may result from a sudden, violent contraction of the flexor carpi ulnaris against the fixed wrist [36].

Classification

Xiong et al. (2010): This classification system correlates tendon injury with three distinct fracture types of the hamate hook. Type I is defined as an avulsion fracture at the tip of the hamate hook. Type II describes a fracture located in the middle part of the hamate hook. Type III identifies a fracture at the base of the hamate hook [78].

Other Considerations: Fractures of the hook of the hamate are rare injuries [6]. The most usual mechanism is a direct blow to the area of the hook [6]. These fractures can also occur by direct impact applied to the hamate during a fall on the heel of the hand [49], or by microtraumatism in sports requiring repeated use of a racquet or a bat [49]. A combined intraarticular fracture of the body and hook of hamate is an extremely rare injury pattern that requires a high index of suspicion for diagnosis [24].

Clinical Presentation

Diagnosis and Diagnostic Challenges

Hook of hamate fractures are frequently misdiagnosed due to the limitations of standard clinical assessment [21]. Specifically, fractures of the pisiform and hamulus are not visible on standard two- or three-view wrist radiographs [26]. Combined intraarticular fractures involving both the body and hook of the hamate represent an extremely rare injury pattern that requires a high index of suspicion for accurate diagnosis [24]. Timely and appropriate diagnosis and treatment of hook of hamate fractures are essential to prevent long-term complications [14].

Physical Examination

Pain over the ulnar-palmar base of the hand should prompt a presumptive diagnosis of hook of hamate fracture until proven otherwise [32]. In a study of acute hook of hamate fractures, volar tenderness on palpation over the hook was present in 100% of cases [70]. The hook of hamate pull test is an easy, cheap, sensitive, and specific clinical test that can be readily performed in the clinic to diagnose these fractures [25]. In the same study of acute injuries, the pull test was painful for all patients [70].

Imaging

A new radiographic view is recommended in addition to standard views for all cases of suspected hook of hamate fractures [7]. Lateral trispiral tomography is clearly superior to other diagnostic methods for hamate hook fractures [41]. CT scan demonstrates 95% specificity and 95% accuracy in diagnosing hamulus fractures [34].

Mechanisms and Specific Populations

Hook of hamate fractures are relatively common in baseball players [71]. In professional bowlers, stress fractures of the hook of hamate have been attributed to a new drilling layout of the bowling ball and recent technical changes during the ball’s release [29]. These changes redistribute micro-constraints on the hook of the hamate using an indirect mechanism of injury through the ligaments and flexor tendons [29].

Investigations

Clinical Examination: Any patient presenting with pain over the ulnar-palmar base of the hand requires a carpal tunnel view, with the presumptive diagnosis of a hook of hamate fracture maintained until proven otherwise [32]. These injuries are rare, typically resulting from a direct blow to the area of the hook [6, 15]. Misdiagnosis remains a significant clinical challenge, as illustrated by cases where hook fractures were initially overlooked [21].

Plain radiography: Standard two- or three-view wrist examinations do not visualize fractures of the hook of the hamate [26]. Consequently, these injuries may be difficult to diagnose when standard x-rays appear normal, particularly for non-hand surgeons [1]. A new radiographic view is recommended in addition to the standard projections in all cases of suspected hook fractures [7]. Radiographic evaluation using the carpal tunnel view has identified three variations of the hook of hamate [84].

MRI: MRI is the modality of choice for imaging radiographically occult fractures of the hand and wrist [61]. Its primary advantages over CT and radiography include improved tissue characterization, particularly of soft tissues such as ligamentous structures and synovium, and the absence of ionizing radiation [61]. Modern MRI systems operate at 1.5T or 3T, with 3T preferred for hand and wrist imaging, especially for small fields of view [61]. A properly performed, high-resolution MRI aids in evaluating ligament injuries of the wrist [67]. For analyzing interosseous, intrinsic, and extrinsic ligament insertions, a static magnetic field strength of at least 1.5 T using a dedicated wrist coil is recommended [67]. The volar extrinsic, SL interosseous, dorsal intercarpal, and LT ligaments are best visualized using 1 mm slices with no interslice gap in the coronal plane [67]. The DRC and intercarpal ligaments are best viewed on both coronal and sagittal images [67]. Oblique axial views along the longitudinal axes of these ligaments allow further analysis, especially when an injury is suspected [67]. Bone marrow edema on MRI may reveal fractures of the carpal bones or distal radius that are radiographically occult [69].

CT: CT scanning enables the 3D analysis of carpal dysfunction [67]. By adding motion in real time (4D CT), this modality may hold promise in the future to potentially quantify the location and degree of injury noninvasively and help surgeons plan their surgical treatment [67].

Other Considerations: Dynamic fluoroscopy shows abnormal motion between the scaphoid and lunate and changes in the kinematics of the midcarpal joint [67]. Live imaging shows whether the DISI is reducible, giving the physician valuable information as the treatment is planned [67]. Arthroscopy is considered by many to be the diagnostic intervention of choice for determining the degree of injury to the wrist and can assess the condition of the cartilage [67]. The degree of intrinsic and extrinsic ligament injury can be identified from the arthroscopic evaluation [67].

Treatment

Non-Operative

Hamate hook fractures diagnosed early may heal with nonoperative management [16]. The data support the recommendation that these fractures can be successfully treated acutely by immediate immobilization [3]. In athletes, acute hook of hamate fractures may be treated with casting or allowed to return to play with nonunion addressed later via excision [42]. For nonunion of the hook of the hamate caused by repeated stress, ultrasound treatment might be useful [47], and low-intensity pulsed ultrasound may be useful in the treatment of ununited fractures [51].

Operative

Indications: Surgical excision is indicated for symptomatic partial union of the hook of the hamate fracture in athletes [9]. It remains an effective method of management for both acute and chronic hook of hamate fractures in professional baseball players [28]. In younger patients with nonunion, repair of the nonunion should be aimed at rather than simple excision to preserve grip strength [20].

Surgical Approach / Technique: Surgical excision is safe and allows a relatively rapid return to play [4]. The open carpal tunnel approach is a successful technique for open excision of symptomatic ununited hook of hamate fractures, characterized by familiarity, ease of performance, excellent visualization, and low morbidity [22]. A modified surgical approach through Guyon’s Canal and the proximal ulnar border of the carpal tunnel allows direct visualization of the motor branch of the ulnar nerve and preserves the nerve supply and blood supply to the hypothenar muscles [33]. The lateral approach to the hook of hamate for its fracture is believed to replace the conventional volar approach because of its benefits in terms of time, safety, and simplicity [43]. For fixation, a simplified dorsal approach with percutaneous fixation with screws avoids damage to the blood supply of the hamate, surrounding soft tissues, and the ulnar nerve, while preserving important stabilising ligaments [46].

Outcomes: Surgical excision carries a low risk of minor complications [28]. MLB players sustaining hook of hamate fractures can reasonably expect to return to their pre-injury performance levels following operative treatment [74]. Patient outcomes were good to excellent regardless of the treatment chosen, with minimal pain and good hand functionality [45].

Biomechanical Considerations: The hamate hook provides some biomechanical advantage for flexor tendon function, and cadaveric changes in tendon force after its excision suggest that power grip may be decreased after hamate hook excision [44].

Complications

Nonunion and Osteonecrosis

The vascularity of the hook of the hamate creates vulnerability to osteonecrosis and nonunion [3]. In younger patients with nonunion of the hook of the hamate, repair of the nonunion is preferred over simple excision to preserve grip strength [20]. Bone grafting of the nonunion resulted in range of motion and grip strengths equivalent to the unoperated side [31].

Tendon Rupture

Closed rupture of the flexor tendons of the little finger can occur secondary to non-union of the hook of the hamate [35]. The period from palmar injury to tendon rupture in cases of secondary flexor tendon rupture ranged from 6 months to 25 years [35]. In cases of closed flexor tendon rupture secondary to hamate non-union, grip strength was an average of 83% of the contralateral hand [35].

Diagnostic Challenges

Fractures of the hook of the hamate have been misdiagnosed in clinical practice [21]. An incidence of 2.7% of acute hook of hamate fracture was identified in association with high-energy distal radius fractures in patients undergoing CT evaluation [17].

Post-Surgical Outcomes and Regeneration

Surgical excision of the hook of the hamate is associated with a low risk of minor complications in professional baseball players [28]. Dorsal percutaneous cannulated mini-screw fixation for non-displaced acute fractures and delayed union of the hamate hook is associated with minimal morbidity and complications [5]. The open carpal tunnel approach for excision of symptomatic ununited hook of hamate fractures is associated with low morbidity [22].

Recovery

Non-Operative Management

No evidence is provided in the current dataset regarding recovery timelines, rehabilitation protocols, or functional milestones for non-operative management of hook of hamate fractures.

Operative Management

Functional milestones: Surgical excision of hook of hamate fractures in high-level amateur athletes results in the achievement of normal function as measured by validated objective outcome measures [27]. In a professional bowler with a stress fracture, functional recovery of the hand was satisfactory 2.5 months after surgical resection of the hamate’s hook [29].

Other Considerations: Surgical excision in high-level amateur athletes allows for successful return to sports participation at preinjury performance levels [27] and results in significant reduction in pain and high overall patient satisfaction [27]. Dorsal percutaneous cannulated mini-screw fixation can treat non-displaced acute fractures and delayed union of the hamate hook successfully with minimal morbidity and complications [5]. The open carpal tunnel approach is a successful technique for open excision of symptomatic ununited hook of hamate fractures due to its familiarity, ease of performance, excellent visualization, and low morbidity [22].

Complications and Long-Term Outcomes

No evidence is provided in the current dataset regarding specific complications or long-term outcome data for this section.

Key Evidence

  • [Paper] Hook of hamate fractures, with normal standard x-rays, may be difficult to diagnose, especially for a nonhand surgeon. [1] (10.1016/j.hcl.2021.06.013)
  • [L4] Fractures of the hook of the hamate have been infrequently reported in the literature. [2] (10.1016/0020-1383(89)90169-1)
  • [L5] The data support the recommendation that hamate hook fractures can be successfully treated acutely by immediate immobilization. [3] (10.1016/0363-5023(93)90405-r)
  • [L4] In most cases, surgical excision as treatment for hook of the hamate fractures is safe and allows a relatively rapid return to play. [4] (10.1016/j.jhsa.2017.06.108)
  • [L4] This pilot study demonstrates that non-displaced acute fractures and delayed union of the hamate hook can be treated successfully by dorsal percutaneous cannulated mini-screw fixation with minimal morbidity and complications. [5] (10.1142/s0218810412970039)
  • [L4] Fractures of the hook of the hamate are rare injuries, with the most usual mechanism being a direct blow to the area of the hook. [6] (10.1016/0266-7681(85)90019-1)
  • [L5] We recommend this view, in addition to the standard ones, in all cases of suspected fractures of the hook of the hamate. [7] (10.1016/s0363-5023(88)80026-1)
  • [L4] The treatment of choice for a symptomatic nonunion, and possibly for an acute fracture, appears to be surgical excision of the hook of the hamate. [8] (10.1016/s0363-5023(88)80107-2)
  • [L4] This condition should be managed no differently from a symptomatic nonunion, with excision of the hook of the hamate and repair of the ligament attachments. [9] (10.1177/03635465030310010201)
  • [L4] Both surgical procedures appear to yield acceptable outcomes in the treatment of hook of hamate fractures. [10] (10.1016/j.jhsg.2023.11.011)
  • [L4] Hook of hamate regeneration can occur after fracture fragment excision. [11] (10.1016/j.jhsg.2024.08.008)
  • [L4] Early and late surgical excision of the hook of the hamate leads to excellent results with return to preinjury levels of activity. [12] (10.1053/j.otsm.2010.03.003)
  • [L5] The author maintains that repair by open reduction and internal fixation for ununited fracture hook of the hamate is not only feasible but also desirable, both for preservation of grip strength and complete relief of pain. [13] (10.1016/0363-5023(89)90032-4)
  • [L4] Appropriately diagnosing and treating hook of the hamate fractures in a timely manner after injury can prevent long-term complications. [14] (10.2519/jospt.2010.0408)
  • [L4] Fractures of the hook of the hamate are rare injuries, with the most usual mechanism being a direct blow to the area of the hook. [15] (10.1016/0266-7681_85_90019-1)
  • [L4] Our results show that hamate hook fractures that are diagnosed early may heal with nonoperative management. [16] (10.1016/0363-5023(92)90363-t)
  • [L4] The series identified an incidence of 2.7% of acute hook of hamate fracture in association with high-energy distal fractures in patients undergoing CT evaluation of the wrist. [17] (10.1177/1753193411436293)
  • [L5] Excision of the osseous fragment with smoothing of the rough bony surfaces is uniformly recommended when fracture of the hook of hamate is the cause of the rupture. [18] (10.1016/s0363-5023(96)80014-1)
  • [L4] Surgical excision of the hook of the hamate resulted in good postoperative outcomes with a mean follow-up of 6 years. [19] (10.3109/17453679308993670)
  • [L5] In younger patients with nonunion of the hook of the hamate, the author believes one should aim for the repair of the nonunion rather than simple excision to preserve grip strength. [20] (10.1016/s0363-5023(86)80127-7)
  • [L4] Both cases illustrate how fractures of the hook of the hamate were misdiagnosed. [21] (10.1016/s0363-5023(85)80258-6)
  • [Paper] The study highlights the open carpal tunnel approach as a successful technique for open excision of symptomatic ununited hook of hamate fractures, because of its familiarity, ease of performance, excellent visualization and low morbidity. [22] (10.1016/j.injury.2014.05.008)
  • [L5] The cadaveric study confirms that the dorsal percutaneous approach is a reliable method and provides safe fixation of non-displaced fractures of the hook of hamate. [23] (10.1177/1753193421991761)
  • [L5] Combined intraarticular fracture of the body and hook of hamate is an extremely rare injury pattern requiring a high index of suspicion for diagnosis. [24] (10.1007/s12593-012-0070-2)
  • [L4] The hook of hamate pull test is an easy, cheap, sensitive, and specific test that can be readily performed in the clinic to diagnose hook of hamate fractures. [25] (10.1016/j.jhsa.2010.08.024)
  • [L4] These fractures are not seen on standard two or three view wrist examination. [26] (10.1016/s0736-4679(98)00016-x)
  • [L4] Surgical excision of hook of hamate fractures in high-level amateur athletes allows for successful return to sports participation at preinjury performance levels, achievement of normal function as measured by validated objective outcome measures, significant reduction in pain, and high overall patient satisfaction. [27] (10.1016/j.jhsa.2012.10.011)
  • [L4] Surgical excision remains an effective method of management, with a low risk of minor complications for both acute and chronic hook of hamate fractures in professional baseball players. [28] (10.1016/j.jhsa.2021.03.015)
  • [L5] [29] (10.1016/j.hansur.2016.06.007)
  • [L5] Surgical excision is the treatment of choice for fractures of the hook of the hamate in any athlete, as the incidence of nonunion precludes the use of open reduction internal fixation. [30] (10.1016/j.hcl.2012.05.013)
  • [L4] The range of motion and grip strengths were equivalent on the operated and unoperated sides. [31] (10.1016/s0363-5023(89)80008-5)
  • [L5] The author states that in their institution, anyone with pain over the ulnar-palmar base of the hand should have a carpal tunnel view with the presumptive diagnosis of fracture of the hook of the hamate until proven otherwise. [32] (10.1016/s0363-5023(86)80125-3)
  • [L4] This modified approach allows direct visualization of the vital structures most at risk, including the motor branch of the ulnar nerve, unlike blind or unilateral approaches, and preserves the nerve supply and blood supply to the hypothenar muscles. [33] (10.1016/j.jhsa.2019.07.015)
  • [L5] [34] (10.1016/j.jhsa.2013.06.004)
  • [L4] [35] (10.1016/j.jhsb.2005.12.015)
  • [L5] These findings suggest that such an injury results from a sudden, violent contraction of the flexor carpi ulnaris against the fixed wrist. [36] (10.1016/s0266-7681(96)80043-x)
  • [L5] The distal end of the transverse carpal ligament was located 10 mm from the hook of the hamate. [37] (10.1016/0363-5023(94)90073-6)
  • [L4] Lateral trispiral tomography is clearly superior to other diagnostic methods for hamate hook fractures. [41] (10.1016/0363-5023(88)90217-1)
  • [L5] Acute hook of hamate fractures in athletes may be treated with casting or allowed to return to play with nonunion addressed later via excision; definitive treatment for stress fractures is excision. [42] (10.1016/j.hcl.2012.05.012)
  • [L5] The authors believe this lateral approach should replace the conventional volar approach because of its benefits in terms of time, safety, and simplicity. [43] (10.1016/0266-7681(86)90028-8)
  • [L5] The hamate hook provides some biomechanical advantage for flexor tendon function and cadaveric changes in tendon force after its excision suggest that power grip may be decreased after hamate hook excision. [44] (10.1053/jhsu.2003.50005)
  • [L4] Patient outcomes were good to excellent regardless of the treatment chosen, with minimal pain and good hand functionality. [45] (10.1177/1753193417729603)
  • [L4] This minimally invasive technique avoids damage to the blood supply of the hamate, surrounding soft tissues, and the ulnar nerve, while preserving important stabilising ligaments. [46] (10.3109/02844310801956714)
  • [L4] Ultrasound treatment might be useful for nonunion of the hook of the hamate caused by repeated stress, and we consider that the ultrasound treatment for nonunion of the hook of the hamate is one option in various treatment methods. [47] (10.1007/s00167-003-0425-0)
  • [L5] [49] (10.1097/bth.0b013e31826577f8)
  • [L4] No significant change with finger extension or flexion was noted in either the deep or superficial digital flexor tendons. [50] (10.1142/s2424835519500139)
  • [L5] Based on the results of this case low-intensity pulsed ultrasound may be useful in the treatment of ununited fractures of the hook of hamate. [51] (10.1053/jhsu.2000.jhsu025a0077)
  • [L4] The proposed etiology of the tendon ruptures is chronic repetitive wear and fraying against the rough surface of the hook. [54] (10.1142/s2424835516720164)
  • [L4] [70] (10.1016/j.jhsa.2019.01.014)
  • [L4] [71] (10.1177/2325967121s00552)
  • [L5] [72] (10.1177/17531934241235803)
  • [L3] MLB players sustaining hook of hamate fractures can reasonably expect to return to their pre-injury performance levels following operative treatment. [74] (10.1123/jsr.2017-0071)
  • [L5] [75] (10.1177/17531934241304249)
  • [L4] [78] (10.1177/1753193418823503)
  • [L4] Three variations of the hook of hamate were identified with radiographic evaluation using the carpal tunnel view. [84] (10.1016/j.jhsa.2005.05.018)
  • [L5] In both positions, the ROC of the little finger flexor tendon was significantly smaller than that of the middle finger flexor tendon. [89] (10.1016/j.hansur.2018.10.117)

References

[1] Hook of Hamate Fractures. Hand Clinics. 2021. DOI: 10.1016/j.hcl.2021.06.013

[2] Fractures of the hook of the hamate. Injury. 1989. DOI: 10.1016/0020-1383(89)90169-1

[3] Hook of hamate vascularity: Vulnerability to osteonecrosis and nonunion. The Journal of Hand Surgery. 1993. DOI: 10.1016/0363-5023(93)90405-r

[4] Return to Play and Complications After Hook of the Hamate Fracture Surgery. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.06.108

[5] DORSAL PERCUTANEOUS CANNULATED MINI-SCREW FIXATION FOR FRACTURES OF THE HAMATE HOOK. Hand Surgery. 2012. DOI: 10.1142/s0218810412970039

[6] Fractures of the hook of the hamate. The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 1985. DOI: 10.1016/0266-7681(85)90019-1

[7] Radiographic evaluation of the hook of the hamate: A new technique. The Journal of Hand Surgery. 1988. DOI: 10.1016/s0363-5023(88)80026-1

[8] Excision of the hook of the hamate: A retrospective survey and review of the literature. The Journal of Hand Surgery. 1988. DOI: 10.1016/s0363-5023(88)80107-2

[9] Symptomatic, Partial Union of the Hook of the Hamate Fracture in Athletes. The American Journal of Sports Medicine. 2003. DOI: 10.1177/03635465030310010201

[10] Surgical Management of Hook of Hamate Fractures: A Systematic Review of Outcomes. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2023.11.011

[11] Hook of Hamate Regrowth After Surgical Excision: A Report of Two Cases. Journal of Hand Surgery Global Online. 2024. DOI: 10.1016/j.jhsg.2024.08.008

[12] Hook of the Hamate Fractures. Operative Techniques in Sports Medicine. 2010. DOI: 10.1053/j.otsm.2010.03.003

[13] Fracture of hamate hook. The Journal of Hand Surgery. 1989. DOI: 10.1016/0363-5023(89)90032-4

[14] Hook of the Hamate Fracture. Journal of Orthopaedic & Sports Physical Therapy. 2010. DOI: 10.2519/jospt.2010.0408

[15] Fractures of the Hook of the Hamate. Journal of Hand Surgery. 1985. DOI: 10.1016/0266-7681_85_90019-1

[16] Nonoperative treatment of acute hamate hook fractures. The Journal of Hand Surgery. 1992. DOI: 10.1016/0363-5023(92)90363-t

[17] Concomitant high-energy fractures of the distal radius and hook of hamate. Journal of Hand Surgery (European Volume). 2012. DOI: 10.1177/1753193411436293

[18] Flexor digitorum profundus rupture of the small finger secondary to nonunion of the hook of hamate: A case report. The Journal of Hand Surgery. 1996. DOI: 10.1016/s0363-5023(96)80014-1

[19] Fractures of the hook of the hamate in athletes: 8 cases followed for 6 years. Acta Orthopaedica Scandinavica. 1993. DOI: 10.3109/17453679308993670

[20] Fracture of the hook of the hamate. The Journal of Hand Surgery. 1986. DOI: 10.1016/s0363-5023(86)80127-7

[21] Fractures of the hook of the hamate—A failure of clinical diagnosis. The Journal of Hand Surgery. 1985. DOI: 10.1016/s0363-5023(85)80258-6

[22] Surgical excision of ununited hook of hamate fractures via the carpal tunnel approach. Injury. 2014. DOI: 10.1016/j.injury.2014.05.008

[23] Safety and reliability of the dorsal percutaneous approach for non-displaced hook of hamate fracture: an anatomical study. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193421991761

[24] Combined Intraarticular Fracture of the Body and the Hook of Hamate: An Unusual Injury Pattern. Journal of Hand and Microsurgery. 2013. DOI: 10.1007/s12593-012-0070-2

[25] Hook of Hamate Pull Test. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.08.024

[26] Pisiform and Hamulus Fractures: Easily Missed Wrist Fractures Diagnosed on a Reverse Oblique Radiograph. The Journal of Emergency Medicine. 1998. DOI: 10.1016/s0736-4679(98)00016-x

[27] Outcomes of Hook of Hamate Fracture Excision in High-Level Amateur Athletes. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.10.011

[28] Hook of Hamate Fractures in Major and Minor League Baseball Players. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2021.03.015

[29] Hamate hook stress fracture in a professional bowler: Case report of an unusual causal sport. Hand Surgery and Rehabilitation. 2017. DOI: 10.1016/j.hansur.2016.06.007

[30] Treatment of Fracture of Hook of the Hamate in Baseball Players. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.013

[31] Nonunion of the hook of the hamate: An argument for bone grafting the nonunion. The Journal of Hand Surgery. 1989. DOI: 10.1016/s0363-5023(89)80008-5

[32] Fractures of the hook of the hamate. The Journal of Hand Surgery. 1986. DOI: 10.1016/s0363-5023(86)80125-3

[33] A Modified Surgical Approach Through Guyon’s Canal and the Proximal Ulnar Border of the Carpal Tunnel Allows for Safe Excision of the Hook of the Hamate. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.07.015

[34] Hook of Hamate Fractures. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.06.004

[35] Closed Rupture of the Flexor Tendons of the Little Finger Secondary to Non-Union of Fractures of the Hook of the Hamate. Journal of Hand Surgery. 2006. DOI: 10.1016/j.jhsb.2005.12.015

[36] Combined Fracture of the Hook of the Hamate and Palmar Dislocation of the Fifth Carpometacarpal Joint. Journal of Hand Surgery. 1996. DOI: 10.1016/s0266-7681(96)80043-x

[37] Clinical location of hook of hamate: A technical note for endoscopic carpal tunnel release. The Journal of Hand Surgery. 1994. DOI: 10.1016/0363-5023(94)90073-6

[41] Fracture of the hamate hook. The Journal of Hand Surgery. 1988. DOI: 10.1016/0363-5023(88)90217-1

[42] Hook of Hamate and Pisiform Fractures in Basketball and Hockey Players. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.012

[43] Lateral approach to the hook of hamate for its fracture. The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 1986. DOI: 10.1016/0266-7681(86)90028-8

[44] Biomechanical evaluation of flexor tendon function after hamate hook excision. The Journal of Hand Surgery. 2003. DOI: 10.1053/jhsu.2003.50005

[45] Diagnosis and management of hook of hamate fractures. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417729603

[46] Simplified dorsal approach to fracture of the hamate hook with percutaneous fixation with screws. Journal of Plastic Surgery and Hand Surgery. 2010. DOI: 10.3109/02844310801956714

[47] Ultrasound treatment of nonunion of the hook of the hamate in sports activities. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-003-0425-0

[49] Hamate Hook Nonunion Treated With a Hook Plate. Techniques in Hand & Upper Extremity Surgery. 2012. DOI: 10.1097/bth.0b013e31826577f8

[50] Sliding Position of the Flexor Tendons Relative to the Hook of Hamate in CT Scans. The Journal of Hand Surgery (Asian-Pacific Volume). 2019. DOI: 10.1142/s2424835519500139

[51] Treatment of ununited fracture of the hook of hamate by low-intensity pulsed ultrasound: A case report. The Journal of Hand Surgery. 2000. DOI: 10.1053/jhsu.2000.jhsu025a0077

[54] Closed Rupture of the Flexor Tendon Secondary to Sclerosis of the Hook of the Hamate: A Report of Two Cases. The Journal of Hand Surgery (Asian-Pacific Volume). 2016. DOI: 10.1142/s2424835516720164

[59] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 2Musculoskeletal Trauma Surgery > FRACTURES AND DISLOCATIONS OF THE DISTAL AND MID-FOREARM.

[60] Aaos Comprehensive Orthopaedic Review 3. Carpal Instability* > II. Anatomy and Biomechanics (See Chapter 92).

[61] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Imaging: Advances in Imaging of the Hand and Upper Extremity > Magnetic Resonance Imaging.

[62] Aaos Comprehensive Orthopaedic Review 3. Anatomy of the Hand and Wrist > VII. The Wrist.

[65] Campbell S Operative Orthopaedics 4 Volume Set. NERVE INJURIES AT THE LEVEL OF THE HAND AND WRIST > CIRCULATION.

[67] Green S Operative Hand Surgery. Advanced Imaging.

[69] Campbell S Operative Orthopaedics 4 Volume Set. WRIST AND ELBOW.

[70] Minimally Invasive Fixation With a Volar Approach Using a Cannulated Compression Screw for Acute Hook of Hamate Fractures. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.01.014

[71] PAPER 14: Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00552

[72] The aetiology of fracture and nonunion in the hook of the hamate. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241235803

[74] Performance Outcomes After Hook of Hamate Fractures in Major League Baseball Players. Journal of Sport Rehabilitation. 2018. DOI: 10.1123/jsr.2017-0071

[75] Re: Campbell FC, Jones SW, Campbell DA. The aetiology of fracture and nonunion in the hook of the hamate. J Hand Surg Eur. 2024, 49: 1172-8. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241304249

[78] Computerized tomographic prediction of flexor tendon injuries complicating hamate hook fractures. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193418823503

[84] Anatomic Variations of the Hook of Hamate and the Relationship to Carpal Tunnel Syndrome. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2005.05.018

[89] The pulley function of hamate hook for the flexor tendon and the change in the curvature radius before and after hamate hook excision. Hand Surgery and Rehabilitation. 2018. DOI: 10.1016/j.hansur.2018.10.117

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