The lateral approach compared with the volar approach for exposure of the hook of the hamate

Abstract

Two cases of delayed union of the hook of the hamate were satisfactorily treated by excisional surgery. The volar surgical approach through the palm is common, but to expose the hook some hypothenar muscles and cardinal ligaments must be divided. Care must be taken to avoid injury of the motor and sensory branches of the ulnar nerve that occur close to the hook. The lateral approach between the abductor digiti minimi muscle and the fifth metacarpal bone is easier and less traumatic. This approach is also safer for the ulnar neurovascular bundle, which is protected by volar retraction and the hypothenar muscles. The lateral approach is advantageous unless the injury is complicated by ulnar nerve palsy or flexor tendon injury.