Fracture of the hook of the hamate: radiographic visualization

The diagnosis of fracture of the hook of the hamate is rarely made at the time of the initial injury. Routine roentgenograms of the hand in the standard three positions do not visualize this structure. The carpal tunnel view (CTV) with hyperextension of the wrist may be too painful to position. A computerized tomography of the wrist in the transverse or axial plane will clearly and painlessly identify the fracture. Placing both hands and wrists in the praying position gives excellent comparison and documents any developmental bone abnormality. Scintigraphy, when positive, must be followed by tomography or a carpal tunnel view.