title: Patient with a Hook of the Hamate Fracture Presenting as Vascular Occlusion: Diagnosis Made with Bedside Ultrasound.
abstract: BACKGROUND
  Hook of the hamate fractures are particularly rare carpal fractures with significant morbidity if not diagnosed early. Classically, these fractures occur from localized blunt trauma to the hook of the hamate in racket sports. Common complaints include pain localized in the hypothenar eminence and reduced grip strength. Hook of the hamate fractures have the potential to cause significant injury to the ulnar nerve and artery.
  
  
  METHODS
  We present the case of a 43-year-old man with hypothenar pain, paresthesias of the fifth finger and ulnar aspect of the fourth finger, and pallor of the fourth and fifth fingers. Using bedside ultrasonography, the patient was found to have a fracture of the hook of the hamate that was causing compression of the ulnar artery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Fracture of the hook of the hamate is often not seen on x-ray studies, and fracture fragments can cause compression of adjacent structures, including the ulnar and median nerves and ulnar artery. Bedside ultrasound may be a useful adjunct in the diagnosis of this carpal fracture when standard x-ray studies do not show a fracture and clinical presentation is concerning for the diagnosis.
authors.affiliation: Sparrow Health Systems, Michigan State University Emergency Medicine Residency, Lansing, Michigan.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Maier
authors.affiliation: Sparrow Health Systems, Michigan State University Emergency Medicine Residency, Lansing, Michigan.
authors.forename: Mary
authors.initials: M
authors.lastname: Hughes
authors.affiliation: Katranji Hand Center, East Lansing, Michigan.
authors.forename: Abdalmajid
authors.initials: A
authors.lastname: Katranji
mesh_terms: D000328:Adult; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging; D051225:Hamate Bone / Q000098:blood supply* / Q000293:injuries*; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology; D010292:Paresthesia / Q000150:complications / Q000209:etiology; D019095:Point-of-Care Systems / Q000592:standards; D017535:Ulnar Artery / Q000002:abnormalities / Q000000981:diagnostic imaging; D014463:Ultrasonography / Q000379:methods*
keywords: fracture; hamate; ulnar artery; ulnar nerve; ultrasound