Hamate Fractures: The Broken Wrist With a Twist

If you took Latin in school—and remember any of it—you might be able to guess the root word of your wrist’s hamate. It’s hamalus, meaning “little hook.” The hamate bone is one of eight bones (or “carpals”) in your wrist joint, and its distinctive feature is a protrusion called the hook. And that’s where hamate fractures tend to occur.

Broken hamates—typically diagnosed in young-adult and early-adult athletes and active types—are rare, thought to account for just 2% of all carpal damage. So, why worry about a hamate fracture if it’s such a rare injury? Left untreated, broken bone fragments can damage nearby tendons and nerves, reducing function in other parts of your hand and wrist. 

Keep reading to learn about a broken hamate, including what this wrist injury feels like, how it’s treated, and things you can do to help prevent it.

What Is a Hamate Fracture?

The hamate is a chunky bone, like an irregularly shaped rock. It’s located between the pinky and ring fingers. Trace those two fingers down through the palm to the wrist and you’ll find the hamate. 

There are two parts to the hamate bone: the body and the hook. The body is the bulk of the bone. The hook is a tab-shaped piece protruding from the side toward the pinky. Hamate fractures can be chronic or acute, and they’re categorized as hook or body injuries.

Hook of Hamate Fractures (Type 1)

Hook of hamate fractures are caused by pressure to the palm, usually from firmly gripping a racket, bat, stick, or club. They are the most common type of hamate wrist fracture.

Body of Hamate Fractures (Type 2)

Body of hamate fractures often happen as a result of forceful impacts to the bone from activities like punching. These injuries to the hamate body often aren’t isolated. They may occur alongside other wrist fractures or dislocated fingers.

Broken Hamate Causes

A 2019 study found that hamate fractures are the top reason for wrist surgery among Major League Baseball athletes. But, you don’t have to be a professional ball player to break your hamate bone.

Playing sports, even at an amateur level, can cause hamate fractures. That’s because certain sports put the hamate bone through a lot of wear and tear. As you train and become stronger, the power you’re able to generate also grows. 

But, as your power increases, so does the stress on your hands and wrists. It’s this increased stress that increases your odds of experiencing a hamate bone fracture. 

You are at a higher risk of a hamate fracture if you participate in these sports:

• Tennis
• Pickleball
• Squash
• Racketball
• Golf
• Boxing
• Hockey
• Baseball
• Softball
• Weightlifting

Hamate bone injuries can occur from a sudden, powerful blow to the hand or sustained pressure on the palm from a piece of equipment, like the butt of a tennis racket or baseball bat. In both cases, the hand absorbs the force and can send that energy to the hamate bone, causing a fracture. 

Hamate fractures often result from these specific athletic actions:

• Strongly gripping a tennis racket, golf club, baseball bat, or hockey stick while striking the ball or puck
• Catching hard-thrown baseballs or softballs in a glove or bare-handed
• Punching or hitting, as in boxing and mixed martial arts
• Lifting excessively heavy weights

Other causes of hamate fractures include falls, motor vehicle accidents, and crush injuries.

Preventing Hamate Bone Fractures

Using proper technique is the best way to prevent fracturing your hamate from playing sports. Remember to take the time to warm up properly before playing to lower your risk of possible injury. Additionally, especially if participating in contact sports, always wear protective pads like wrist guards. Make sure your gear fits properly to maximize its benefit. 

You can also avoid potential trouble with hamate fractures associated with playing sports by following these tips:

• Use the correct grip in any sport that requires firmly holding equipment
• Be careful not to grip the golf club too tightly, or hit a tree root with the club head, delivering a blow to the palm
• Think twice about smashing that tennis racket or golf club on the ground after a bad shot, causing undue stress on the hand
• Work your way up to lifting heavy weight
• Keep your eye on a hockey puck so you don’t miss it and hit the ice, driving the stick into your hand
• Don’t use a worn-out baseball glove and leave your palm uncushioned
• Avoid catching a baseball or softball bare-handed

Signs You Might Have a Broken Hamate Bone

Usually, it’s not immediately obvious that you’ve suffered a fracture to the small hamate bone, which is why this type of wrist injury often goes underreported. 

Hamate fracture symptoms are relatively mild and similar to other common hand and wrist problems. At first, hamate fractures can easily be mistaken for a wrist sprain until the condition begins affecting a tendon or nerve, causing more severe pain. 

Because the hamate bones are located so deep within the wrist, breaks don’t always show up on images. This is why wrist specialists often perform hamate fracture tests as part of the diagnosis process.

See an experienced wrist specialist immediately if you experience any of the primary symptoms below for a day or two and suspect you may have suffered a hamate fracture.

Pain

Mild to severe discomfort from hamate fractures can show up in various forms.

• On the ulnar side of your palm (ulnar means the side by the pinky finger)
• On the ulnar underside of the wrist 
• On the ulnar side of the wrist while grasping
• While applying pressure to the pinky finger under resistance
• When gripping sporting equipment
• When hitting or throwing a ball
• When tapping the wrist on a hard surface

Reduced Range of Motion

Hamate fractures make it difficult to extend the ring and pinky fingers. 

Swelling and Tenderness

The ulnar underside of the wrist is typically sore and inflamed.

Other symptoms associated with hamate fractures

• Weakened grip strength
• Tingling in the ring and pinky fingers
• Spasms

Possible Complications

Hamate fractures carry a substantial risk of complications because they are hard to see on some imaging scans and may not be diagnosed properly by a doctor without extensive wrist experience. 

Some tendons and a major nerve are next to the hook of the hamate bone. Injuries to the hamate can affect those components. The longer the injury isn’t diagnosed, the greater the chance of these complications.

Ulnar Nerve Compression

The primary complication in hook of hamate injuries is a pinching of the ulnar nerve, which provides feeling to the ring and pinky fingers and strength to the small muscles in your hand. The ulnar nerve passes through Guyon’s canal near the hamate. Broken hamate bone fragments can damage this nerve—especially in undiagnosed fractures—causing numbness, tingling, and weakness in the related fingers.

Nonunion

If the bone fragments of a broken hamate don’t heal properly (called a “nonunion”), it can result in chronic pain and instability.

Tendon Injuries

Displaced pieces of the broken hamate bone or even the healing response can irritate or rupture the flexor tendons, which control the movement of your ring and pinky fingers. 

Post-Traumatic Wrist Arthritis

A hamate that isn’t treated early enough or properly can lead to arthritis in the wrist.

How Broken Hamate Bones Are Diagnosed

First, a specialist will perform a physical exam, looking for signs of hamate fractures, particularly when the hook of the hamate may be the problem. A doctor familiar with hamate fractures should perform a “pull test,” a targeted hamate fracture test to assess pain, specialized x-rays, or a CT scan may be ordered to confirm a fracture and its severity.

Hamate Fracture Treatments

For a broken hamate bone, treatment depends on the severity of the injury and whether the fracture is displaced or nondisplaced. A displaced fracture means the bones have moved out of alignment. A nondisplaced fracture means the bones remain aligned, which may be repaired nonsurgically with the use of a hamate fracture splint or cast. 

Non-Surgical Care Options

If you have a minor, nondisplaced injury, a wrist specialist may recommend casting or splinting for several weeks (while also avoiding gripping and heavy lifting), especially if you don’t need to return to an athletic activity immediately.

Additionally, occupational therapy is almost always necessary to regain full range of motion after a hamate fracture injury. Your wrist specialist may refer you to a certified occupational therapist to help you with personalized exercises designed to strengthen your muscles so you can return to full activity.

Surgical Intervention

If your wrist specialist recommends surgery, the procedure typically involves removing fragments of a broken hook of the hamate or a procedure called an open reduction and internal fixation. During an ORIF, a wrist surgeon repositions the displaced, fractured hamate and repairs the bone with screws and wires to relieve pain and restore your mobility. 

FAQs About Hamate Fractures

Here’s what you need to know about recovery time, distinguishing hamate fractures from other wrist injuries, and what tests work.

How Long Does a Broken Hamate Take to Heal?

Six to eight weeks is a typical recovery time whether the hamate injury was treated with a cast or with surgery. Patients may need several weeks of physical therapy, which can begin immediately after surgery or after the cast is removed. Complications—such as nerve damage—may prolong hamate fracture recovery time.

Learn about advanced treatment options for nerve pain relief

Is a Broken Hamate Ever Mistaken for Something Else?

Yes. A hook of the hamate fracture may look like a simple wrist sprain if it’s not caught. Other issues with similar symptoms: ligamentous injuries, carpal tunnel syndrome, ulnar nerve entrapment, a scaphoid fracture, and injuries to the flexor/extensor carpi ulnaris tendons (ECU and FCU).

Can a Hamate Fracture Heal on Its Own?

Usually not. At the very least, the hamate bone needs to be immobilized for the broken pieces to reattach and grow back together. 

How Are Colles Fractures Different From Hamate Fractures?

A Colles fracture affects the arm’s radius bone, not the hamate bone. This injury occurs to part of the radius called the distal, which is located near the wrist joint. A Colles fracture is considered a broken wrist. A hamate fracture affects the wrist as well as the palm and fingers.

How Does the “Pull Test” for Hamate Fractures Work?

During a pull test, the patient flexes the ring and pinky fingers while the doctor applies pressure to them, gauging the pain level and location. The pull test is considered highly reliable for diagnosing hamate fractures, particularly hook of the hamate fractures.

What’s the Difference Between a Boxer’s Fracture and a Hamate Fracture? 

A boxer’s fracture occurs to the bone of the pink finger (specifically the neck of the bone, below the knuckle), while a hamate fracture is located on the hamate bone, deeper in the wrist. Both can be caused by hitting or punching. 

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The Benefits of Specialized Care for Hamate Fractures

Your wrists, and their hamate bones, are workhorses, constantly performing simple hand gestures and everyday tasks. Proper care is essential for maintaining this critical functionality. Wrist specialists have advanced knowledge of the complex structure of the wrist and the various injuries with overlapping symptoms. 

Compared to general practitioners and primary care providers, wrist specialists are specially trained to read hamate care radiology scans, pinpoint the source of pain, make a correct diagnosis, and start a personalized treatment plan as quickly as possible to reduce recovery time and the risk of complications, such as chronic pain. 

Seek the care of a wrist specialist for a suspected hamate fracture to optimize the chance of making a full recovery as soon as safely possible.

Why Choose the Hand and Wrist Specialists at IHTSC 

The Indiana Hand to Shoulder Center is home to leading hand and wrist specialists with vast experience treating injuries and conditions, both common and rare. Our providers often see patients with complex wrist injuries that other doctors couldn’t repair. 

For the most advanced, comprehensive care for complex injuries such as hamate fractures, trust the distinguished wrist surgeons at the IHTSC. 

Call (317) 743-3985 or schedule an appointment online.

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Medically reviewed by Brandon Smetana, MD