Hamate fractures present with pain within the ulna aspect of the hand, i.e., closer to the pinky side of the hand. Typically, there is a history of trauma or perhaps a history of pain after the use of racquet and/or club type sports, i.e., golf, tennis or baseball. A diagnosis of a hook of the hamate fracture is made on exam, clinical suspicion and confirmed with either an MRI or a CAT Scan, if x-rays are equivocal. It is important to address the fracture at the level of the hook of the hamate because of its precarious blood supply. If unattended, there can be significant complications secondary to the fracture including rupture of the flexor tendons to the small and ring finger, and compression of the ulna nerve with subsequent problems in the hand. Treatment involves surgical excision of the fragment of the hook of the hamate. This is done under regional anesthesia on an outpatient basis. Postoperatively, the patient is splinted for approximately a week and begins active range of motion of the wrist and hand to regain maximal function.