A Modified Surgical Approach Through Guyon's Canal and the Proximal Ulnar Border of the Carpal Tunnel Allows for Safe Excision of the Hook of the Hamate.

Hook of the hamate fractures can be treated by various methods including cast immobilization, open reduction, and internal fixation and excision. Usually, those individuals who elect for excision have acute fractures and need to return to sporting activity or work quickly or have nonunions with persistent symptoms. There is a paucity of descriptions in the literature and textbooks of a technique to safely excise the hook of the hamate. The authors present a method of safely exposing and removing the hook of the hamate by visualizing the potential structures at risk: the motor branch of the ulnar nerve, the ulnar digital nerve to the little finger, and the flexor tendons to the ring and little fingers by an approach through Guyon's canal and the proximal ulnar border of the carpal tunnel.