Hamate and CMC Fracture-Dislocation Fixation Info Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, matches the treatment to your specific injury. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. At the clinic, your history, examination and scans establish the diagnosis.
This operation lines up the broken hamate bone and the joints at the base of your fingers, and holds them in place while they heal. It is usually offered when the bone has moved out of place, or when the finger joints are unstable. Some injuries can be treated without surgery if they are found early and the joint sits back in place and stays there. When the joint will not stay in place, or the injury is more severe, surgery is recommended. In these injuries, surgery aims to prevent lasting deformity and loss of hand function. Most people who have this operation regain good movement and strength in the hand. We will discuss the options with you and decide together on the treatment that suits your injury.
Before the operation
You will need some scans before surgery, such as X-rays, an MRI or an ultrasound. These show where the bone has broken and whether the finger joints have shifted, which helps plan the operation. Bring a list of your current medications to your appointment. Some medications may need to be paused before surgery, and your surgeon will tell you which ones and for how long. Stop eating and drinking seven hours before your operation so your surgery time can be brought forward if the theatre list runs early; your surgeon will give you exact instructions about fasting and drinking. Arrange for someone to drive you home afterwards, and wear loose, comfortable clothing. If you have other medical conditions, you may need blood tests or a review with the anaesthetist (the doctor who gives the anaesthetic).
On the day
On the day of your operation, you come to the hospital's surgical admissions unit. You are checked in there and prepared for theatre. You will then meet the anaesthetist, the doctor who gives the anaesthetic. This operation is done under general anaesthetic. You will be fully asleep for the operation. Some patients may also have a regional nerve block for post-operative pain relief; the anaesthetist decides on the day based on your individual circumstances.
After that, you are taken into the operating theatre, where the operation is performed. When it is finished, you wake up in the recovery area. Nurses watch over you there while the anaesthetic wears off. Once you are stable, you either go to the ward or go home. Which of these happens depends on the procedure and on how your recovery is going.
What the operation involves
There are two ways your surgeon can do this operation, and the choice depends on your injury. If the broken pieces can be lined up without opening the skin, your surgeon works through small puncture wounds. The bones are guided back into place and held with fine wires, or sometimes a screw, passed in through those small openings. If the fragments need to be seen and fitted back together, your surgeon makes a single cut over the broken bone instead. This open approach is used when the break goes into the joint, when the bone is in several pieces, or when the pieces will not line up on their own.
Once your surgeon can reach the injury, the bones are put back where they belong. The bases of your ring finger and little finger are lined up with the hamate, the wrist bone they normally sit against. Fine wires are then passed across the joints to hold everything steady while it heals. These wires stay in for several weeks and are removed later. Where the hamate itself has broken into a large piece, small screws may be used to hold it together. Occasionally a small plate is needed as well. Your surgeon chooses the combination that suits your particular fracture.
When the bones are lined up and held firmly, your surgeon checks the position before finishing. The cut is then closed with stitches. A dressing goes over the top, and you will keep that dressing on for about 10 days. Your surgeon will explain how the wires are removed and when that happens as part of planning your recovery with you.
After the operation
You wake up in the recovery ward, where nurses keep an eye on you as the anaesthetic wears off. Your hand will be in a splint with dressings over the wounds, and we will give you pain relief to keep you comfortable. You can get up and move around as soon as you feel steady; your hand does the healing, so walking is fine. Someone should stay with you for the first 24 hours after you go home. You may go home the same day or stay one night in hospital after this operation. Both are common, and your team will talk with you about which suits you. We leave the dressing on for about 10 days; please do not take it off before then unless we tell you to. We change or remove it when we see you.
Recovery
For the first few days your hand will be sore and swollen. This settles gradually. Keeping your hand raised on a pillow, even at night, helps the swelling go down. The pain relief we give you keeps you comfortable while this happens.
Your hand will be in a splint made by your hand therapist, Ruby Doolan at Extend Rehabilitation. She will also guide your exercises once the splint comes off. You should not drive while the splint is on, because it stops you gripping the steering wheel safely. Once the splint is off and your surgeon clears you, you can drive again. Our page on driving after upper-limb surgery explains this in more detail.
At home, you can do most light daily tasks once you feel steady. Walking is fine from early on. You will avoid heavy lifting and anything that puts strain on the healing hand until your therapist says it is safe. As the swelling settles and movement returns, you will start gentle exercises to loosen the fingers and wrist. Grip strength builds gradually as the bone heals.
Most people notice steady improvement over time. Once you can grip without pain, more activities become possible, and heavier work and sport come later in your recovery. Recovery varies between individuals, so your timeline may differ. Your surgeon and your hand therapist will guide you at each stage and tell you what is safe to do next.
What can go wrong
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
Sometimes a joint at the base of a finger can slip partway out of place again after surgery. You might notice a clicking or grinding feeling, a change in the shape of the finger base, or pain that returns once it had started to settle. If you feel this, call the clinic rather than waiting for your next visit.
A joint can also stay out of place without showing clearly on a standard X-ray. If your finger keeps feeling unstable or painful after surgery, tell your surgeon. Further scans may be needed to find the cause.
Timing matters with these injuries. When treatment is delayed, the joint is harder to hold in place and the result may not be as good. If your injury happened some time ago and you have not yet seen a surgeon, mention this at your appointment so it can be planned around.
If you notice any of these changes, contact the clinic. If pain is severe, or the hand becomes hot, red or increasingly swollen, seek urgent care at an emergency department. For anything less urgent, bring it up at your next review so it can be checked properly.
The complications table on this page lists typical rates if you want the specifics.
When to call us
Call us if you have a fever, or the wound becomes red, hot or starts to leak fluid. Call us if pain suddenly gets worse, or your hand changes colour or feeling. Go to emergency if you cannot move your fingers, or your hand becomes numb, very swollen or very painful. Go to emergency if you have calf swelling or shortness of breath. These can be signs of a blood clot. If you are unsure, call the clinic. We would rather hear from you early than late.
