Excision Hook of Hamate for Nonunion

Nonunion may be visible on carpal tunnel view; if not, it should be easily visualized on CT scan.

Figure 32-1

Palmar approach, radial aspect of hypothenar eminence. In patients with thick palms exposure may be facilitated by extending incision across wrist crease (Fig. 32-1).
Split muscles of the hypothenar region longitudinally.
Identify and mobilize the ulnar nerve, particularly the motor branch as it sweeps around the ulnar aspect of the hamate hook (Fig. 32-2).
Peel periosteum off of hamate hook.
Excise hook and repair periosteum over exposed bone (Fig. 32-3A,B).