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ORIF - Screw fixation

For the fixation of hamate hook fractures, mini-fragment screws (1.5 or 2.0 mm) may be used as a position screw.

Overdrilling for compression is often not possible due to the small fragment size. Headless compression screws are too big and, therefore, not an option to fix this fracture.

Hamate hook fractures may occasionally be associated with a palmar fracture of the trapezium in high-energy injuries as they are linked through the transverse carpal ligament.

$Hamate hook fracture –Screw fixation$

The patient is usually supine with the arm on a radiolucent side table.

Patient in supine position with the arm on a radiolucent side table

An ulnar approach gives access to the hamate hook.

Note: During all steps of surgery (approach, reduction, screw fixation, or fragment excision), protection of the deep (motor) branch of the ulnar nerve is mandatory!

If the fracture is displaced, reduce it with a hook and hold the reduction throughout the procedure.

In most cases, there is not enough room for temporary K-wire fixation.

$Hamate hook fracture –Reduction$

Drilling

Use only the dedicated drill bit. A power drill will exert a smaller and more controlled force on the fragments than manual drilling and reduce the risk of displacing the fragment. A small power drill with slow rotation is preferable.

Use irrigation solution to cool the drill bit to minimize thermal injury.

Check the position of the tip of the drill bit using image intensification.

$Hamate hook fracture – Screw fixation: drilling$