Clinical Example: Hook of hamate nonunion excision

Hook of hamate fractures are prone to nonunion, and their diagnosis is frequently delayed or missed. Cronic nonunions may result in flexor tendon rupure and other complications. Treatment for most patients is excision of the small fracture fragment. 

 
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This chronically painful nonunion was not visible on PA, lateral and oblique films, but can be seen clearly on this supinated oblique hamate hook view:
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and on this slightly different angle of the same view
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Incision, directly over the prominence of the hook
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Hook exposed. The ulnar artery and nerve are retracted radially.
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Hook excised.
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Fibrous white nonunion tissue is visible at the base.
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