J Korean Soc Surg Hand.  2016 Mar;21(1):16-22. 10.12790/jkssh.2016.21.1.16.

Hamate Hook Fracture with Flexor Tendon Ruptures as a Golf Injury

• Kim JM
• Paeng JW
• Yoo MJ
• Woo SH

• KMID: 2161159
• DOI: http://doi.org/10.12790/jkssh.2016.21.1.16

Abstract

PURPOSE
We report surgical results and the relationship between hamate hook fracture and flexor tendon rupture occurred during excessive golf practice or rounding.
METHODS
The 16 cases of patients with fracture of hamate hook or flexor tendon injury caused by golf swing were examined retrospectively. Hamate hook excision were underwent in fracture alone, flexor tendon reconstruction with tendon transfer of 3rd or 4th flexor digitorum sublimus (FDS) were done in the flexor tendon rupture. Postoperative results were evaluated by means of American Society for Surgery of the Hand (ASSH) to compare total range of motion and the grip strength.
RESULTS
The fracture gap was not far apart completely in computed tomography (CT) of hamate fracture alone cases. If the flexor tendon rupture with the fracture, the gap in CT was far apart completely. After flexor tendon transfer surgery, two cases were excellent, five cases were good, two cases were fair in ASSH assessment. One case was re-rupture. Grip strength as compared with the normal side was observed for the mean grip strength of 82% recovery.
CONCLUSION
The instability of the hamate hook fracture affected to flexor tendon rupture rather than location of the fracture. Hamate hook excision and tendon transfer with FDS can be a good treatment option.

Keyword

Hamate hook; Flexor tendon; Fracture; Rupture; Tendon transfer; Golf

MeSH Terms

Golf*
Hand
Hand Strength
Humans
Range of Motion, Articular
Retrospective Studies
Rupture*
Tendon Injuries
Tendon Transfer
Tendons*

Figure

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  Fig. 1. (A) The zigzag incision on the palm to avoid median and ulnar nerve injury and to find out proximal stump of ruptured flexor tendon as well as hamate hook fracture. (B) Fracture fragment was excised from the hamate. (C) View of ruptured 5th flexor digitorum profundus (FDP). (D) The periosteum over the hook site was repaired to construct a smooth tunnel floor over the base of the excised hook. (E) 1 cm-transverse incision was made over volar digitopalmar crease and 4th flexor digitorum sublimus (FDS) was divided. (F) Then 4th FDS was sutured to the distal 5th FDP using a Pulvertaft interweaving technique.

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  Fig. 2. Comparative computed tomography scan images of (A). Hamate hook fracture only and (B). Hamate hook fracture with flexor tendon rupture. Note the gap of fracture completely in B.

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  Fig. 3. Preoperative and postoperative clinical photographs. (A) Preoperative photographs showed inability to flex small finger. (B) Postoperative photographs showed nearly full flexion of the small finger.

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