Hook of the hamate fractures. Diagnosis, treatment, and complications.

Four cases of undiagnosed hook of the hamate fracture are presented. In each case, the initial injury was considered trivial; medical attention was not sought until rupture of the little profundus/superficialis tendon occurred. All were treated with excision of the hook and tendon repair, which usually consisted of an end-to-side or "Y" type repair of the little to the ring profundus. Postoperatively, all patients were pain-free; they returned to their respective preinjury activities, although most had some limitation of motion in the digits with the tendon repair. A review of the English literature revealed 127 cases of hook of the hamate fracture, with 14 instances of associated tendon rupture and four histories of tendon fraying. The addition of these four cases constitutes a rupture/injury rate of approximately 14%. Since tendon rupture is a serious problem that not uncommonly follows hook of the hamate fracture, a high index of suspicion must be maintained when initially evaluating these injuries.