What's the diagnosis? By Dr. Erica Schramm


A 45 year old male presents for pain and swelling in his left medial hand days after punching a wall. His x-ray is shown below.  What's the diagnosis?  (Identify the two fractures)  Scroll down for answer.






Boxer’s Fracture:

For a review about Boxer’s Fractures see here http://emdaily.cooperhealth.org/content/whats-diagnosis-dr-michael-tom-1


Hamate Fracture:


  • rare fractures (less than 2% of carpal bone fractures)
  1. hamate body fracture: most common mechanism is a direct blow with a closed fist (punching a wall); body fractures are often associated with a 4th or 5th metacarpal fracture
  2. hook of hamate fracture: most common mechanism is an interrupted swing (with a baseball bat, golf club, etc.); a “carpal tunnel view” x-ray is useful for investigate the hook of the hamate; Guyon’s canal: runs under the hook of the hamate and contains the ulnar nerve and ulnar artery; physical exam should include evaluation of ulnar nerve and artery            
  • point tenderness over the hamate should raise suspicion for a fracture, and if plain films are negative a CT should be considered
  • hook of hamate and non-displaced body fractures can be splinted in the ED with a volar splint and prompt outpatient orthopedics follow up
  • non-union of hamate hook fractures is common and many ultimately require surgery
  • displaced body fractures and fractures with associated signs of neurovascular injury require ORIF




Blome, Andrea L and Megan E Healy. “Wrist.” Simon’s Emergency Orthopedics, 8e. Scott E Sherman Ed. New York, NY: McGraw-Hill, 2019.

Escarza, Robert et al. “Wrist Injuries”. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Judith E Tintinalli, et al. New York, NY: McGraw-Hill, 2016.