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Twenty-nine patients with hamate fractures were treated. The two main types of hamate fractures are hook fractures (type 1) and body fractures (type 2). We sub-divided type 2 fractures according to the fracture line into coronal, type 2a and transverse, type 2b. There were 15 type 1, 11 type 2a and three type 2b fractures. For type 1, nine were treated with excision, one with open reduction and internal fixation (ORIF) and five with cast immobilisation, in which two resulted in non-union followed by excision. For type 2, five type 2a cases were treated with ORIF and the others with closed reduction and pinning.

Most of the patients had satisfactory results at the seventh month follow-up. However, those with associated neurovascular and musculotendinous injuries were likely to have unfavourable results. On the basis of study findings, it appears that functional results are influenced mainly by the associated soft tissue damage.

We report the usefulness of hook of hamate pull test (HHPT), described by Wright et al. in 2010, along with therapeutic outcomes of hook of hamate fractures. Eleven patients (two with fresh fractures and nine with nonunion) were studied. The fractures were diagnosed with HHPT for recently encountered 4 patients and a definitive diagnosis was made by a carpal canal view and a computed tomography (CT) scan. Treatment involved cast immobilization for one fresh fracture case, and bone fragment removal immediately over the hook for ten others. HHPT was positive in all the four cases. Union was achieved by conservative treatment, and hypothenar pain disappeared after surgery. Patients returned to work/sports two months postoperatively. HHPT was useful for diagnosing both fresh fractures and nonunion. If HHPT is positive, CT should be performed even if the fracture is obscure on a carpal canal view.

Hamate hook fractures are rare injuries but appear to occur frequently in underwater rugby, the reason for which was investigated in this study.

High-level underwater rugby players with hook fractures diagnosed during a five-year interval (2005–2010) were studied retrospectively. Medical data on these patients were reviewed for information on the mechanism of injury, type of fracture, radiological imaging, treatment, and outcome.

In ten patients, hook fractures of the leading hand were confirmed by computed tomography, all of which were associated with specific injuries during underwater rugby games. Conservative treatment resulted in delayed healing or non-union, wherefore fragment excision and open reduction and internal fixation was performed in ten and five patients, respectively, while two patients declined surgery. After surgery, all patients were able to play underwater rugby again.

In underwater rugby, hook fractures occur frequently due to high and repeated forces applied to the leading hand during games.

Background: The excision of the hook of the hamate is an accepted modality for the treatment of hook of hamate fractures. Three surgical approaches to the hook of hamate have been described in literature. This includes two palmar approaches namely the Guyon canal approach and the carpal tunnel approach, and the lateral approach. The aim of this article is to compare the outcomes of the carpal tunnel approach and the lateral approach.

Methods: Twenty-four patients with hook of hamate fractures were treated by excision of the hook of hamate. The hook of hamate was approached via the carpal tunnel in 15 patients and via the lateral approach in 9 patients. The outcomes with regard to duration of the surgery, complications such as pain, sensory disturbance and scar problems and time to return to sports were measured and analysed.

Results: There were no significant differences in outcomes between the carpal tunnel and the lateral approach for excision of hook of hamate fractures.

Conclusions: The outcomes of excision of the hook of hamate via the carpal tunnel approach and the lateral approach are similar. The decision to choose an approach should be based on the surgeon's familiarity with the approach. Future studies should include a comparison with the Guyon canal approach preferably in a homogenous group of patients.

Level of Evidence: Level IV (Therapeutic)