The hamate is one of the eight carpal bones of the wrist. Like any bone, the carpal bones can fracture from a fall or acute trauma. But the hamate is unusual — it has a triangular body and a bony projection called the hook, and that hook is particularly prone to fracture. So what causes a hook of hamate fracture, and what should you do about it?
Fractures of the hook of the hamate make up only 2% of wrist fractures. They’re challenging to diagnose and difficult to heal — which is why they’re worth knowing about.
What causes a hook of hamate fracture?
The mechanism differs from other wrist fractures. These fractures occur in people playing sports that involve gripping an object. The typical injury is hitting the ground with a golf club, or swinging awkwardly at a ball with a baseball bat. Golfers, baseball players, and hockey players make up the majority of cases.
Sometimes a hook of hamate fracture follows a direct blow to the wrist, or a fall onto an outstretched hand.
Symptoms and diagnosis
After a hook of hamate fracture, people report:
- Pain at the fracture site — on the little finger (ulnar) side of the palm, just below the wrist crease
- Swelling and bruising in the wrist
- Grip weakness
- Pins and needles in the palm side of the ring and little fingers, indicating that the ulnar nerve is affected
When examining a possible fracture, it’s essential to check the ulnar nerve. This nerve runs close to the hook of the hamate and can be damaged by the fracture, causing weak grip strength — a condition known as Guyon’s canal syndrome.
The hook of hamate pull test
Pressing directly over the hook is the most sensitive sign of a fracture, but the pull test also helps. We ask you to bend the ring and little fingers against resistance, which pulls on the tendons and reproduces pain at the fracture site.
Why the fracture is often missed
Be careful about imaging. Standard wrist X-rays frequently miss a hook of hamate fracture. A specific view — the carpal tunnel view — detects it far more reliably. A CT scan or MRI is often used to confirm the diagnosis. A missed fracture is a common reason for persistent wrist pain after a golf or racquet-sport injury.
Treatment of a hook of hamate fracture
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These fractures are difficult to treat because the blood supply to the hook is poor, which leads to delayed healing or non-union.
For an undisplaced fracture, we use cast immobilisation for 6–8 weeks. These fractures heal well with strict immobilisation, though there’s a small risk of delayed or non-union. After the cast comes off, physiotherapy restores range of motion, strength, and movement control.
For a displaced fracture, we recommend surgery to fix it internally with a specific type of screw. Evidence suggests post-surgical healing is excellent.
Managing complications of a wrist fracture golf
Sometimes fractures fail to heal, causing chronic pain and reduced grip strength. Studies suggest delayed union and non-union occur in about 50% of cases. In these cases, we recommend removing the hook, often releasing the ulnar nerve at the same time. Complete excision leads to excellent outcomes after about eight weeks. There are risks with this surgery, including nerve injury, infection, and reduced grip strength.
Ulnar nerve irritation occurs in around 20% of cases and is also treated by removing the hook.
Frequently asked questions about hamate fractures: wrist golf fracture
Why is a hook of hamate fracture so often missed?
Standard wrist X-rays don’t show the hook well, so the fracture is easily overlooked — and the symptoms (vague wrist pain and grip weakness) are non-specific. A carpal tunnel view X-ray, CT, or MRI is needed. This is why persistent wrist pain after a golf or bat injury deserves proper imaging.
How long does a hook of hamate fracture take to heal?
An undisplaced fracture is immobilised in a cast for 6–8 weeks, followed by physiotherapy. Healing can be slow because the blood supply to the hook is poor, and about 50% develop delayed union or non-union — in which case removing the hook usually gives an excellent result within about eight weeks.
Can you play golf with a hook of hamate fracture?
Not during treatment. Gripping is exactly the action that caused the injury, and continuing to play risks non-union. Return to golf comes after the fracture has healed and grip strength has been restored through rehabilitation.
Do you always need surgery for a hook of hamate fracture?
No. An undisplaced fracture is treated in a cast. Surgery is recommended for displaced fractures and for fractures that fail to heal—where the hook is excised, usually with an excellent outcome.
Are body fractures of the hamate common?
No. When they do occur, they’re often associated with fractures of other carpal bones or wrist dislocations. Body fractures can lead to carpal instability and need review by a hand surgeon.
Final word from Sport Doctor London about hook of hamate fracture
Hook of hamate fractures are rare, occurring mainly in people who grip objects in sport. Most report pain and reduced grip strength on the little finger side of the wrist and hand. We recommend cast immobilisation for 6–8 weeks, though around 50% prove difficult to heal — and a missed fracture is a common cause of ongoing wrist pain.
If you have persistent wrist pain after a golf or racquet injury, Dr Masci can assess you in London, including ultrasound in clinic. Contact the team here or call +44 (0) 203 488 0350.
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