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Introduction: Baseball players are susceptible to a number of characteristic upper extremity injuries due to the nature of the sport. Among these injuries are fractures of the hook of the hamate. The purpose of this study was to determine the cause of these injuries and the short-term impact on the playing habits of competitive baseball players.

Materials & Methods: A retrospective chart review was performed on all patients with hook of hamate fractures between the years 2000 until 2012. The primary inclusion criteria were 1) competitive baseball players and 2) surgical treatment of the injury. Patient demographics, mechanism of injury, surgical treatment and outcome were collected from the medical records. Information on return to play was collected from the internet when applicable.

Results: There were seven male patients (1 major league, 2 minor league, 3 college and 1 high school patient) that underwent eight procedures. The mean age at the time of surgery was 21.7 (18-26) years. All patients were concomitantly diagnosed with ulnar tunnel syndrome. Six cases presented with acute fractures and 2 cases were considered non-unions. The mechanism of injury was attributed to batting in 6 cases, and due to rogue pitches in two cases. The dominant hand was involved in 4 cases. The median time between injury and surgery was 33 (3-270) days. All surgeries consisted of hook of hamate excision and ulnar tunnel decompression. One patient had concomitant carpal tunnel release. One complication occurred in one patient who experienced scar hypersensitivity. Three patients played with the injury until the end of the season (2 college, 1 minor league). Two players (major league and college) had surgery during the season and missed 28 and 25 games respectively. One minor league player missed 36 games of a new season recovering from surgery.

Conclusion: Fractures of the hook of the hamate are common in competitive baseball players and may present either as acute fractures or chronic non-unions. The injury mechanism is often predictable, most often arising secondary to repetitive swinging and may occur at all levels of competitive baseball. Hook of hamate excision and ulnar tunnel surgical decompression provide excellent outcomes, with minimal complications and return to play is expected. More efforts should be focused on prevention of this injury.