# Hook of Hamate Fracture

> NEET-PG Orthopaedics hook of hamate fracture covers golf and racquet injury, carpal tunnel view imaging, nerve and tendon complications and excision.

- Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/hook-of-hamate-fracture
- Exam / course: NEET-PG · Subject: Orthopaedics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Green's Operative Hand Surgery; Campbell's Operative Orthopaedics; Maheshwari's Essential Orthopaedics
- How to cite: "Hook of Hamate Fracture", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/hook-of-hamate-fracture

## Direct answer

A hook of hamate fracture is a break of the hook, the palmar projection of the hamate, usually caused by a direct blow from a golf club, tennis racquet or bat. It is easily missed on a routine radiograph, and it can injure the ulnar nerve, the ulnar artery or the flexor tendons of the ring and little fingers. Symptomatic fractures are often treated by excising the hook.

## What you must remember

- **Mechanism:** a direct blow or repeated impact from the club handle or racquet, the classic injury in golfers, tennis players and baseball batters.
- **Anatomy:** the hook forms the ulnar wall of the carpal tunnel and the radial border of Guyon canal, lying beside the ulnar nerve and artery.
- **Symptoms:** pain and tenderness over the hypothenar eminence, pain on gripping, and weakness of grip.
- **Imaging:** a dedicated carpal tunnel radiograph shows the hook better than a routine view, and CT is the most reliable test for the fracture.
- **Nerve and artery:** ulnar nerve palsy or ulnar artery thrombosis can follow, because the fragment lies in Guyon canal.
- **Tendon complication:** rupture of the flexor digitorum profundus to the ring and little fingers can occur late, from attrition on the sharp fragment.
- **Treatment:** excision of the hook for symptomatic chronic or non-united fragments, with fixation an option in selected acute fractures.

## A stepwise approach from suspicion to surgery

Hook of hamate fracture is suspected from the sport history and the hypothenar tenderness, and then confirmed by specific imaging. The steps below follow the logic that examiners expect.

1. **Take the sport history:** a golfer or racquet player with hypothenar pain after a swing or stroke makes the diagnosis likely.
2. **Examine the nerve and tendons:** the ulnar nerve is tested for sensation and intrinsic power, and flexor function of the ring and little fingers is checked.
3. **Image with a dedicated view:** a carpal tunnel radiograph shows the hook, and CT confirms the fracture and defines the fragment.
4. **Assess the artery:** the ulnar artery is examined for thrombosis or aneurysm, since the hook lies beside it in Guyon canal.
5. **Decide on fixation or excision:** an acute fresh fracture may be fixed in selected cases, while a chronic or non-united fragment is excised.
6. **Follow up for complications:** grip strength and tendon function are reviewed after excision or fixation.

## Where the exam tries to catch you

Hook of hamate questions are usually decided by remembering that the injury is easily missed and that it threatens nerve, artery and tendon.

- **Trap:** dismissing hypothenar pain after a golf swing as a simple sprain. **Correct:** the hook fracture is missed on routine radiographs, so a carpal tunnel view or CT is needed.
- **Trap:** treating a symptomatic hook fracture with casting. **Correct:** casting is often unreliable for the hook, and a symptomatic non-united fragment is usually excised.
- **Trap:** ignoring the tendons and nerve. **Correct:** the hook lies beside the flexor tendons and the ulnar nerve and artery, so these complications must be sought.

## Frequently asked questions

### Why is a hook of hamate fracture often missed on X-ray?

A hook of hamate fracture is often missed on X-ray because the hook projects palmarly and is obscured on routine views. A dedicated carpal tunnel radiograph shows the hook more clearly. CT is the most reliable test when a fracture is still suspected.

### Which tendons are at risk after a hook of hamate fracture?

The flexor digitorum profundus tendons to the ring and little fingers are at risk after a hook of hamate fracture. Rupture can occur late, from attrition on the sharp fragment. This complication is one reason symptomatic fragments are removed.

### When is excision of the hook of hamate indicated?

Excision of the hook of hamate is indicated for symptomatic chronic or non-united fragments, especially those causing pain or nerve and tendon problems. Fixation is an option in selected acute fractures. The choice depends on the fracture pattern and the timing of presentation.

### Why does the ulnar nerve matter in hook of hamate fracture?

The ulnar nerve matters because the hook lies beside it in Guyon canal, so fragments or nonunion can compress it. Ulnar nerve palsy with intrinsic weakness and sensory loss may follow. Excision of the hook is often performed to relieve this compression.