title: Therapeutic alternatives in nonunion of hamate hook fractures: personal experience in 8 patients and review of literature.
abstract: Symptomatic nonunion frequently results after conservative treatment of hamate hook fractures, emphasizing the need of appropriate surgical strategies. A retrospective analysis of 8 patients with nonunions treated by fragment excision or open reduction and internal fixation (ORIF) at 3 centers was performed. The literature was reviewed for treatment options, as bone grafting and low-intensity pulsed ultrasound. Although fragment excision is advocated as the "gold standard" in nonunion, reports on functional results are controversial, and recent anatomic and biomechanical studies of the hook challenge this opinion. In our patients, complete relief of symptoms and comparable functional results were observed after ORIF or fragment excision. Bone grafting could supplement ORIF in selected cases. Low-intensity pulsed ultrasound may evolve as a conservative treatment option. Several alternatives to hook excision are available aiming at complete anatomic and functional recovery of hamate hook nonunion. Further experience is needed before general recommendations can be formulated.
authors: Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Switzerland. oscheufler@uhbs.ch
authors: Oliver
authors: O
authors: Scheufler
authors: Sebastian
authors: S
authors: Radmer
authors: Detlev
authors: D
authors: Erdmann
authors: Günter
authors: G
authors: Germann
authors: Gerhard
authors: G
authors: Pierer
authors: Reimer
authors: R
authors: Andresen
mesh_terms: D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery; D051225:Hamate Bone / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D014463:Ultrasonography