Hamate Hook and Pisiform Fractures

Though rare, hook of hamate (hamulus) fractures and pisiform fractures are serious injuries in the athlete that should not be missed or underestimated. Failure to promptly diagnose and treat these fractures may lead to serious complications including avascular necrosis, nonunion, tendon rupture, carpal instability, neurovascular compression, and arthritis. Hamulus fractures should be suspected in the athlete with persistent hypothenar hand, particularly those who use a bat, racket, or club. Complete hamulus excision after fracture has been shown to provide consistent pain relief and return to sport. Pisiform fractures are uncommon. Excision may provide benefit in the setting of a displaced fracture. Return to sport after any carpal fracture should focus primarily on the future health of the athlete, with future play only as a secondary aim.