Headless screw fixation versus fragment excision for hook of hamate fractures using a mini-carpal tunnel approach: a retrospective cohort study

Purpose: This retrospective cohort study compared the clinical outcomes of headless-screw open reduction and internal fixation (ORIF) and fragment excision for hook of hamate fractures performed through a mini-carpal tunnel approach. We evaluated radiographic union rates, functional recovery, and postoperative complications.Methods: In this retrospective, single-center cohort study, 23 surgically treated patients (11 ORIF; 12 fragment excision) were included between January 2022 and February 2025. Data extracted from electronic health records included age, injury-to-surgery interval (ITS), pain measured using the visual analog scale (VAS), wrist range of motion (ROM), neuritic symptoms, and return-to-play (RTP) time. Outcomes were compared between the two operative groups using appropriate statistical analyses.Results: Patients in the ORIF group were younger (31.4±13.1 years vs. 42.6±19.7 years) and underwent surgery significantly earlier (ITS, 4.9±5.9 weeks vs. 31.1±29.5 weeks) than those in the excision group. ORIF achieved a radiographic consolidation rate of 90.9% (10/11 cases). Functional recovery outcomes—including mean RTP (6.27±1.19 weeks for ORIF vs. 5.50±0.90 weeks for excision; Welch p=0.10), pain (VAS, 1.82±1.25 vs. 1.67±1.15; p=0.73), and near-symmetric wrist ROM—were comparable between groups. The mini-open approach allowed direct visualization of the fracture site and was associated with low complication rates and an absence of neuritic symptoms in the ORIF cohort.Conclusion: Headless-screw ORIF performed through a mini-carpal tunnel approach achieved high union rates and functional outcomes comparable to fragment excision while preserving native carpal biomechanics. Despite baseline differences between groups, these findings suggest that headless screw ORIF is a feasible structure-sparing option with outcomes comparable to fragment excision in this small cohort.