Hamate Fracture: Difference between revisions
mNo edit summary |
(replace n+1 occurence of name content) |
||
| Line 14: | Line 14: | ||
== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
The hamate bone is a triangular bone located in the distal carpal row and is situated on the ulnar side. He is composed of a body and a hook. Hamate fractures constituted about 2% of all carpal fractures.<ref name="drie">Rainer Schmitt; Ulrich Lanz; Diagnostic imaging of the hand; THIEME; 2008</ref><ref name="vier">Rosemary Prosser,W. Bruce Conolly; Rehabilitation of the hand and upper limb; 2003</ref> They are classified as type I fractures involving the hook and type II fractures involving the body. Type I fractures are more common than type II fractures.<ref name="p5">Amy Powell et al.; http://emedicine.medscape.com/article/97813-overview; Updated: May 13, 2008</ref><br>The hamate is bordered proximally by the pisiform and the lunate in the proximal carpal row, radially by the capitate, and distally by the bases of the fourth and fifth metacarpals.<ref name="vijf" | The hamate bone is a triangular bone located in the distal carpal row and is situated on the ulnar side. He is composed of a body and a hook. Hamate fractures constituted about 2% of all carpal fractures.<ref name="drie">Rainer Schmitt; Ulrich Lanz; Diagnostic imaging of the hand; THIEME; 2008</ref><ref name="vier">Rosemary Prosser,W. Bruce Conolly; Rehabilitation of the hand and upper limb; 2003</ref> They are classified as type I fractures involving the hook and type II fractures involving the body. Type I fractures are more common than type II fractures.<ref name="p5">Amy Powell et al.; http://emedicine.medscape.com/article/97813-overview; Updated: May 13, 2008</ref><br>The hamate is bordered proximally by the pisiform and the lunate in the proximal carpal row, radially by the capitate, and distally by the bases of the fourth and fifth metacarpals.<ref name="vijf"/><br>The Guyon canal carries the ulnar artery and nerve, for this reason hook fractures should suggest a high probability of ulnar artery and nerve damage.<br><br> | ||
== Mechanism of Injury / Pathological Process<br> == | == Mechanism of Injury / Pathological Process<br> == | ||
Hamate fractures are most often seen in racquet, club or bat sports.<br>Racquet sports, like tennis, cause impact of the grip against the hook of the hamate of the dominant hand where as in golf, baseball and hockey the club will impact against the hamate in the non-dominant hand.<ref name="p6" | Hamate fractures are most often seen in racquet, club or bat sports.<br>Racquet sports, like tennis, cause impact of the grip against the hook of the hamate of the dominant hand where as in golf, baseball and hockey the club will impact against the hamate in the non-dominant hand.<ref name="p6"/><br>Type I fractures involving the hook of the hamate can occur via several different mechanisms:<ref name="p1">Hirano K, Inoue G. Classification and treatment of hamate fractures. Hand Surg. 2005; 10(2-3):151-7. (A2)</ref><ref name="p2">Guha AR, Marynissen H. Stress fracture of the hook of the hamate. Br J Sports Med. Jun 2002; 36(3):224-5. (B)</ref><ref name="p5" /> | ||
- Repeated micro trauma<br> - Direct trauma<br> - Indirect trauma | - Repeated micro trauma<br> - Direct trauma<br> - Indirect trauma | ||
| Line 24: | Line 24: | ||
<br>Repeated micro trauma to the hook in sports involving swinging clubs, bats, or racquets can result in a hook stress fracture. These are usually occurring in the non-dominant hand. | <br>Repeated micro trauma to the hook in sports involving swinging clubs, bats, or racquets can result in a hook stress fracture. These are usually occurring in the non-dominant hand. | ||
<br>Direct trauma can be applied during sports when the butt of the club rests on the hamate and the force of the swing is then transmitted directly to the bone. A fall onto the outstretch hand or fall on the hand while holding an object but is also seen in particular sporting activities.<ref name="p6" | <br>Direct trauma can be applied during sports when the butt of the club rests on the hamate and the force of the swing is then transmitted directly to the bone. A fall onto the outstretch hand or fall on the hand while holding an object but is also seen in particular sporting activities.<ref name="p6"/> | ||
<br>Indirect trauma can be applied to the hook through its muscular and ligamentous attachments. This can occur either when falling on a hyperextended wrist or during power grips.<ref name="drie" /> | <br>Indirect trauma can be applied to the hook through its muscular and ligamentous attachments. This can occur either when falling on a hyperextended wrist or during power grips.<ref name="drie" /> | ||
| Line 32: | Line 32: | ||
== Clinical Presentation == | == Clinical Presentation == | ||
Point tenderness on the hypothenar and weak grip are characteristics of hamate fractures. Patients typically present with pain and tenderness over the hamate. Ulnar and median neuropathy can also be seen, as well as rare injuries to the ulnar artery. Displaced hamate fragments and hematoma as well as nonunion of the hook of the hamate can lead to neuropathy of the deep branch of the ulnar nerve, lesion of the median nerve, or even rupture of deep flexor tendons IV and V. Decreased sensation or weakness may be due to ulnar or median nerve injury. The fracture fragments may injure the nerves directly or swelling and inflammation may injure them indirectly.<ref name="p2" | Point tenderness on the hypothenar and weak grip are characteristics of hamate fractures. Patients typically present with pain and tenderness over the hamate. Ulnar and median neuropathy can also be seen, as well as rare injuries to the ulnar artery. Displaced hamate fragments and hematoma as well as nonunion of the hook of the hamate can lead to neuropathy of the deep branch of the ulnar nerve, lesion of the median nerve, or even rupture of deep flexor tendons IV and V. Decreased sensation or weakness may be due to ulnar or median nerve injury. The fracture fragments may injure the nerves directly or swelling and inflammation may injure them indirectly.<ref name="p2"/><ref name="drie" /><ref name="p8">Mark D. Bracker; The 5-minute Sports Medicine Consult; Wolters Kluwer; 2011</ref><ref name="p4">Kenneth A. Egol, Kenneth J. Koval, Joseph D. Zuckerman; Handbook of fractures; Wolters Kluwer; 2010</ref><br>With a fracture of the hook of the hamate there might be pain on the dorso-ulnar aspect of the wrist.<ref name="p2" /><br><br> | ||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
| Line 38: | Line 38: | ||
An oblique x-ray view or a carpal tunnel view should be considered as part of the initial diagnostic investigations. It can help with diagnosis and give further important information to aid appropriate management.<ref name="vijf">Vishal H Borse, James Hahnel, Adnan Faraj; Lessons to be learned from a missed case of Hamate fracture: a case report; Journal of Orthopaedic Surgery and Research; 2010 Aug 27;5:64. (B)</ref> Usually they are negative, a CT scan of the wrist in the “praying position” is the imaging modality of choice.<ref name="p2" /><ref name="p7">Robert E. Carroll, Jeffrey F. Lakin; Fracture of the hook of the hamate: radiographic visualization.; Iowa Orthop J.; 1993;13:178-82. (A1)</ref> A high density CT scan with the wrists in the “praying position” allows comparison between the two wrists. It is reported to have a sensitivity of 100%, specificity of 98.4%, and accuracy of 97.2% and is the radiographic technique of choice in the diagnosis of hook of the hamate fractures.<ref name="p2" /> | An oblique x-ray view or a carpal tunnel view should be considered as part of the initial diagnostic investigations. It can help with diagnosis and give further important information to aid appropriate management.<ref name="vijf">Vishal H Borse, James Hahnel, Adnan Faraj; Lessons to be learned from a missed case of Hamate fracture: a case report; Journal of Orthopaedic Surgery and Research; 2010 Aug 27;5:64. (B)</ref> Usually they are negative, a CT scan of the wrist in the “praying position” is the imaging modality of choice.<ref name="p2" /><ref name="p7">Robert E. Carroll, Jeffrey F. Lakin; Fracture of the hook of the hamate: radiographic visualization.; Iowa Orthop J.; 1993;13:178-82. (A1)</ref> A high density CT scan with the wrists in the “praying position” allows comparison between the two wrists. It is reported to have a sensitivity of 100%, specificity of 98.4%, and accuracy of 97.2% and is the radiographic technique of choice in the diagnosis of hook of the hamate fractures.<ref name="p2" /> | ||
<br>Fractures of the body of the hamate are difficult to diagnose. AP (anteroposterior), lateral and oblique views are more useful for diagnosis of body fractures than for hook fractures. The oblique and lateral views are the most useful. When routine films are negative and when a fracture is highly suspected, a CT scan should be taken.<ref name="p8" | <br>Fractures of the body of the hamate are difficult to diagnose. AP (anteroposterior), lateral and oblique views are more useful for diagnosis of body fractures than for hook fractures. The oblique and lateral views are the most useful. When routine films are negative and when a fracture is highly suspected, a CT scan should be taken.<ref name="p8"/> Assessments of the degree of angulations, reduction and articular incongruence or subluxation are the important imaging findings.<ref name="p6">Philip Robinson; Essential radiology for sports medicine; Springer; 2010</ref><br><br> | ||
The hook of the hamate pull test (HPPT) is a clinical test for diagnosing a hook of hamate fracture.<ref name="p3">Thomas W. Wright, Michael W. Moser, Deenesh T. Sahajpal; Hook of the hamate pull test; J Hand Surg Am. 2010 Nov; 35 (11): 1887-1889. (B)</ref><br> | The hook of the hamate pull test (HPPT) is a clinical test for diagnosing a hook of hamate fracture.<ref name="p3">Thomas W. Wright, Michael W. Moser, Deenesh T. Sahajpal; Hook of the hamate pull test; J Hand Surg Am. 2010 Nov; 35 (11): 1887-1889. (B)</ref><br> | ||
| Line 48: | Line 48: | ||
== Management / Interventions<br> == | == Management / Interventions<br> == | ||
Conservative option for nondisplaced fractures is a short-arm cast. The cast should immobilize the metacarpophalangeal joints of the fourth and fifth fingers and be a thumb spica to decrease micrononuinion at the hook. 2 Cast should be worn for 6-8 weeks to prevent nonunion. If pain is still present after cast removal, then excision for nonunion is the treatment of choice.<ref name="p8" | Conservative option for nondisplaced fractures is a short-arm cast. The cast should immobilize the metacarpophalangeal joints of the fourth and fifth fingers and be a thumb spica to decrease micrononuinion at the hook. 2 Cast should be worn for 6-8 weeks to prevent nonunion. If pain is still present after cast removal, then excision for nonunion is the treatment of choice.<ref name="p8"/><br>In the most studies, surgical treatment (fragment excision and open reduction and internal fixation (ORIF)) of a hamate fracture has a higher success rate than after conservative treatment.<ref name="p9">Scheufler O, Radmer S, Erdmann D, Exner K, Germann G, Andresen R.; Current treatment of hamate hook fractures; HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE;2006 Oct;38(5):273-82. (A2)</ref><ref name="p0">Scheufler O, Andresen R, Radmer S, Erdmann D, Exner K, Germann G.; Hook of hamate fractures: critical evaluation of different therapeutic procedures.; PLASTIC AND RECONSTRUCTIVE SURGERY; 2005 Feb; 115(2): 488-497. (A2)</ref><ref name="p1"/><br> | ||
Depending on the injury passive and active exercises are explained and exercised. As the healing of the tissue progresses and the function of the involved joint improves, coordination exercises, exercises against resistance and exercises to restore strength are incorporated into the exercise program.<ref name="boek1">Dr. Louise M. van Dongen et al.; Handboek voor handrevalidatie theorie en praktijk; Bohn Stafleu Van Loghum; 2002</ref> | Depending on the injury passive and active exercises are explained and exercised. As the healing of the tissue progresses and the function of the involved joint improves, coordination exercises, exercises against resistance and exercises to restore strength are incorporated into the exercise program.<ref name="boek1">Dr. Louise M. van Dongen et al.; Handboek voor handrevalidatie theorie en praktijk; Bohn Stafleu Van Loghum; 2002</ref> | ||
| Line 54: | Line 54: | ||
<br>During the first days after injury arises an edema in the hand. This edema is usually located on the dorsum of the hand. As a result, the function of the hand is negatively affected. In extreme swelling the hand must be positioned higher than the elbow.<br>In an intra-articular injury ice will immediately be applicated after the trauma, surgery or exercise to the involved joint to avoid post-traumatic arthritis. <br>During the rehabilitation physiotherapist uses passive mobilizations to normalize the ROM and the rolling and sliding motion of the involved joint. These mobilizations may include traction, translation and angular mobilizations.<br>In intra-articular lesions tractions can be performed to obtain pain relief. If in the last phase of the revalidation there is still capsular retraction, traction and translations can be carried out. During rehabilitation after plaster immobilization of the wrist there will be some stiffness of the capsule in the wrist. Here, traction and translations are performed. The patient is also encouraged to mobilize as much as possible the involved joints in question to optimize the functionality of the member in question as quickly as possible. Patients are encouraged to actively mobilize the adjacent joints to avoid stiffening. <br>After an injury, the balance between phasic and tonic muscles restored. In the hand wrist and finger flexors are tonic muscles. With a hand or wrist injury these muscles show an elevated tone and have the tendency to shorten. The flexors of the hand should be stretched and (as pain and swelling allows) excentric trained.<br>To start building progressive resistance exercises, the fracture has to be sufficiently consolidated. The exercises consist of concentric and eccentric muscle activity, closed and open chain exercises. Resistance exercises are necessary to regain a good functionality of the hand.<ref name="boek">Eric Van den Kerckhove et al.; De kinesitherapeutische behandeling van hand- en polsletsels Oefentherapie en ondersteunende technieken; Standaard uitgeverij; 2009</ref><br> | <br>During the first days after injury arises an edema in the hand. This edema is usually located on the dorsum of the hand. As a result, the function of the hand is negatively affected. In extreme swelling the hand must be positioned higher than the elbow.<br>In an intra-articular injury ice will immediately be applicated after the trauma, surgery or exercise to the involved joint to avoid post-traumatic arthritis. <br>During the rehabilitation physiotherapist uses passive mobilizations to normalize the ROM and the rolling and sliding motion of the involved joint. These mobilizations may include traction, translation and angular mobilizations.<br>In intra-articular lesions tractions can be performed to obtain pain relief. If in the last phase of the revalidation there is still capsular retraction, traction and translations can be carried out. During rehabilitation after plaster immobilization of the wrist there will be some stiffness of the capsule in the wrist. Here, traction and translations are performed. The patient is also encouraged to mobilize as much as possible the involved joints in question to optimize the functionality of the member in question as quickly as possible. Patients are encouraged to actively mobilize the adjacent joints to avoid stiffening. <br>After an injury, the balance between phasic and tonic muscles restored. In the hand wrist and finger flexors are tonic muscles. With a hand or wrist injury these muscles show an elevated tone and have the tendency to shorten. The flexors of the hand should be stretched and (as pain and swelling allows) excentric trained.<br>To start building progressive resistance exercises, the fracture has to be sufficiently consolidated. The exercises consist of concentric and eccentric muscle activity, closed and open chain exercises. Resistance exercises are necessary to regain a good functionality of the hand.<ref name="boek">Eric Van den Kerckhove et al.; De kinesitherapeutische behandeling van hand- en polsletsels Oefentherapie en ondersteunende technieken; Standaard uitgeverij; 2009</ref><br> | ||
<br>Low-intensity ultrasound has been reported to be useful in promoting fracture healing, it accelerates the normal fracture repair process.<ref name="p2" | <br>Low-intensity ultrasound has been reported to be useful in promoting fracture healing, it accelerates the normal fracture repair process.<ref name="p2"/><br>Ultrasound treatment might be useful for nonunion caused by a repeated stress, the ultrasound is a treatment for nonunion of the hook of the hamate and is an option in various treatment methods.<ref name="p1"/><br><br> | ||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
| Line 64: | Line 64: | ||
== Key Evidence == | == Key Evidence == | ||
Decision between casting and surgery is based on the lifestyle demands of the patient. The athlete who does not want to risk healing a nonunion after casting may opt for surgery to minimize the time away from sport. Similarly, a patient with a job that requires repetitive grabbing, gripping or lifting may elect for excision to reduce the risk of an extended period of time away from work.<ref name="p8" | Decision between casting and surgery is based on the lifestyle demands of the patient. The athlete who does not want to risk healing a nonunion after casting may opt for surgery to minimize the time away from sport. Similarly, a patient with a job that requires repetitive grabbing, gripping or lifting may elect for excision to reduce the risk of an extended period of time away from work.<ref name="p8"/><br> | ||
== Resources <br> == | == Resources <br> == | ||
Revision as of 15:24, 6 June 2017
Be the first to edit this page and have your name permanently included as the original editor, see the editing pages tutorial for help.
|
Original Editor - Joris De Pot Lead Editors |
Clinically Relevant Anatomy
[edit | edit source]
The hamate bone is a triangular bone located in the distal carpal row and is situated on the ulnar side. He is composed of a body and a hook. Hamate fractures constituted about 2% of all carpal fractures.[1][2] They are classified as type I fractures involving the hook and type II fractures involving the body. Type I fractures are more common than type II fractures.[3]
The hamate is bordered proximally by the pisiform and the lunate in the proximal carpal row, radially by the capitate, and distally by the bases of the fourth and fifth metacarpals.[4]
The Guyon canal carries the ulnar artery and nerve, for this reason hook fractures should suggest a high probability of ulnar artery and nerve damage.
Mechanism of Injury / Pathological Process
[edit | edit source]
Hamate fractures are most often seen in racquet, club or bat sports.
Racquet sports, like tennis, cause impact of the grip against the hook of the hamate of the dominant hand where as in golf, baseball and hockey the club will impact against the hamate in the non-dominant hand.[5]
Type I fractures involving the hook of the hamate can occur via several different mechanisms:[6][7][3]
- Repeated micro trauma
- Direct trauma
- Indirect trauma
Repeated micro trauma to the hook in sports involving swinging clubs, bats, or racquets can result in a hook stress fracture. These are usually occurring in the non-dominant hand.
Direct trauma can be applied during sports when the butt of the club rests on the hamate and the force of the swing is then transmitted directly to the bone. A fall onto the outstretch hand or fall on the hand while holding an object but is also seen in particular sporting activities.[5]
Indirect trauma can be applied to the hook through its muscular and ligamentous attachments. This can occur either when falling on a hyperextended wrist or during power grips.[1]
Type II fractures involving the body of the hamate always requires a direct force.[6] These fractures are typically associated with high-energy, direct-force trauma or contusion injuries.
Clinical Presentation[edit | edit source]
Point tenderness on the hypothenar and weak grip are characteristics of hamate fractures. Patients typically present with pain and tenderness over the hamate. Ulnar and median neuropathy can also be seen, as well as rare injuries to the ulnar artery. Displaced hamate fragments and hematoma as well as nonunion of the hook of the hamate can lead to neuropathy of the deep branch of the ulnar nerve, lesion of the median nerve, or even rupture of deep flexor tendons IV and V. Decreased sensation or weakness may be due to ulnar or median nerve injury. The fracture fragments may injure the nerves directly or swelling and inflammation may injure them indirectly.[7][1][8][9]
With a fracture of the hook of the hamate there might be pain on the dorso-ulnar aspect of the wrist.[7]
Diagnostic Procedures[edit | edit source]
An oblique x-ray view or a carpal tunnel view should be considered as part of the initial diagnostic investigations. It can help with diagnosis and give further important information to aid appropriate management.[4] Usually they are negative, a CT scan of the wrist in the “praying position” is the imaging modality of choice.[7][10] A high density CT scan with the wrists in the “praying position” allows comparison between the two wrists. It is reported to have a sensitivity of 100%, specificity of 98.4%, and accuracy of 97.2% and is the radiographic technique of choice in the diagnosis of hook of the hamate fractures.[7]
Fractures of the body of the hamate are difficult to diagnose. AP (anteroposterior), lateral and oblique views are more useful for diagnosis of body fractures than for hook fractures. The oblique and lateral views are the most useful. When routine films are negative and when a fracture is highly suspected, a CT scan should be taken.[8] Assessments of the degree of angulations, reduction and articular incongruence or subluxation are the important imaging findings.[5]
The hook of the hamate pull test (HPPT) is a clinical test for diagnosing a hook of hamate fracture.[11]
Outcome Measures[edit | edit source]
Management / Interventions
[edit | edit source]
Conservative option for nondisplaced fractures is a short-arm cast. The cast should immobilize the metacarpophalangeal joints of the fourth and fifth fingers and be a thumb spica to decrease micrononuinion at the hook. 2 Cast should be worn for 6-8 weeks to prevent nonunion. If pain is still present after cast removal, then excision for nonunion is the treatment of choice.[8]
In the most studies, surgical treatment (fragment excision and open reduction and internal fixation (ORIF)) of a hamate fracture has a higher success rate than after conservative treatment.[12][13][6]
Depending on the injury passive and active exercises are explained and exercised. As the healing of the tissue progresses and the function of the involved joint improves, coordination exercises, exercises against resistance and exercises to restore strength are incorporated into the exercise program.[14]
During the first days after injury arises an edema in the hand. This edema is usually located on the dorsum of the hand. As a result, the function of the hand is negatively affected. In extreme swelling the hand must be positioned higher than the elbow.
In an intra-articular injury ice will immediately be applicated after the trauma, surgery or exercise to the involved joint to avoid post-traumatic arthritis.
During the rehabilitation physiotherapist uses passive mobilizations to normalize the ROM and the rolling and sliding motion of the involved joint. These mobilizations may include traction, translation and angular mobilizations.
In intra-articular lesions tractions can be performed to obtain pain relief. If in the last phase of the revalidation there is still capsular retraction, traction and translations can be carried out. During rehabilitation after plaster immobilization of the wrist there will be some stiffness of the capsule in the wrist. Here, traction and translations are performed. The patient is also encouraged to mobilize as much as possible the involved joints in question to optimize the functionality of the member in question as quickly as possible. Patients are encouraged to actively mobilize the adjacent joints to avoid stiffening.
After an injury, the balance between phasic and tonic muscles restored. In the hand wrist and finger flexors are tonic muscles. With a hand or wrist injury these muscles show an elevated tone and have the tendency to shorten. The flexors of the hand should be stretched and (as pain and swelling allows) excentric trained.
To start building progressive resistance exercises, the fracture has to be sufficiently consolidated. The exercises consist of concentric and eccentric muscle activity, closed and open chain exercises. Resistance exercises are necessary to regain a good functionality of the hand.[15]
Low-intensity ultrasound has been reported to be useful in promoting fracture healing, it accelerates the normal fracture repair process.[7]
Ultrasound treatment might be useful for nonunion caused by a repeated stress, the ultrasound is a treatment for nonunion of the hook of the hamate and is an option in various treatment methods.[6]
Differential Diagnosis
[edit | edit source]
Differential diagnosis includes:
• Flexor/extensor carpi ulnaris tendon injury
• Metacarpal/carpal bone fracture or contusion
• Triangular fibrocartilaginous complex tear
• Ulnar artery thrombosis
• Ulnar nerve neuropathy
• Carpal tunnel syndrome
Key Evidence[edit | edit source]
Decision between casting and surgery is based on the lifestyle demands of the patient. The athlete who does not want to risk healing a nonunion after casting may opt for surgery to minimize the time away from sport. Similarly, a patient with a job that requires repetitive grabbing, gripping or lifting may elect for excision to reduce the risk of an extended period of time away from work.[8]
Resources
[edit | edit source]
add appropriate resources here
Case Studies[edit | edit source]
add links to case studies here (case studies should be added on new pages using the case study template)
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 1.2 Rainer Schmitt; Ulrich Lanz; Diagnostic imaging of the hand; THIEME; 2008
- ↑ Rosemary Prosser,W. Bruce Conolly; Rehabilitation of the hand and upper limb; 2003
- ↑ 3.0 3.1 Amy Powell et al.; http://emedicine.medscape.com/article/97813-overview; Updated: May 13, 2008
- ↑ 4.0 4.1 Vishal H Borse, James Hahnel, Adnan Faraj; Lessons to be learned from a missed case of Hamate fracture: a case report; Journal of Orthopaedic Surgery and Research; 2010 Aug 27;5:64. (B)
- ↑ 5.0 5.1 5.2 Philip Robinson; Essential radiology for sports medicine; Springer; 2010
- ↑ 6.0 6.1 6.2 6.3 Hirano K, Inoue G. Classification and treatment of hamate fractures. Hand Surg. 2005; 10(2-3):151-7. (A2)
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Guha AR, Marynissen H. Stress fracture of the hook of the hamate. Br J Sports Med. Jun 2002; 36(3):224-5. (B)
- ↑ 8.0 8.1 8.2 8.3 Mark D. Bracker; The 5-minute Sports Medicine Consult; Wolters Kluwer; 2011
- ↑ Kenneth A. Egol, Kenneth J. Koval, Joseph D. Zuckerman; Handbook of fractures; Wolters Kluwer; 2010
- ↑ Robert E. Carroll, Jeffrey F. Lakin; Fracture of the hook of the hamate: radiographic visualization.; Iowa Orthop J.; 1993;13:178-82. (A1)
- ↑ Thomas W. Wright, Michael W. Moser, Deenesh T. Sahajpal; Hook of the hamate pull test; J Hand Surg Am. 2010 Nov; 35 (11): 1887-1889. (B)
- ↑ Scheufler O, Radmer S, Erdmann D, Exner K, Germann G, Andresen R.; Current treatment of hamate hook fractures; HANDCHIRURGIE MIKROCHIRURGIE PLASTISCHE CHIRURGIE;2006 Oct;38(5):273-82. (A2)
- ↑ Scheufler O, Andresen R, Radmer S, Erdmann D, Exner K, Germann G.; Hook of hamate fractures: critical evaluation of different therapeutic procedures.; PLASTIC AND RECONSTRUCTIVE SURGERY; 2005 Feb; 115(2): 488-497. (A2)
- ↑ Dr. Louise M. van Dongen et al.; Handboek voor handrevalidatie theorie en praktijk; Bohn Stafleu Van Loghum; 2002
- ↑ Eric Van den Kerckhove et al.; De kinesitherapeutische behandeling van hand- en polsletsels Oefentherapie en ondersteunende technieken; Standaard uitgeverij; 2009
