Excision of Hook of Hamate Fractures in Elite Baseball Players: Outcomes and Surgical Technique
Gilad Pinchas Eisenberg, MD
Newton Wellesley Hospital, Newton, MA; Tel Aviv Medical Center, Tel Aviv, Israel
Background: Hook of hamate fractures are occuring with increasing frequency in elite baseball players. Early diagnosis followed by surgical intervention expedites return to play.
Purpose: To review the diagnosis, surgical treatment, and outcomes following excision of a hook of hamate fracture in elite baseball players (professional and collegiate). Critical elements of the surgical technique for excision of the hook of hamate are reviewed.
Methods: Retrospective review of 32 consecutive elite baseball players who underwent acute (<3 weeks), subacute (3-6 weeks) and delayed (>6 weeks) surgical excision of 32 hook of hamate fractures that were sustained while competing at professional (16) or varsity collegiate (16) baseball levels. Mean follow up was 10 months. The clinical history, timing of surgery, complications, and time to return to play are reported.
Results: Patients underwent excision of their hook of hamate fracture at a mean of 8 weeks (range 0.5 - 52 weeks) from the onset of symptoms. All patients were able to return to full pre-injury level of baseball participation on average 7 weeks from the date of surgery (range 4-30 weeks). Two patients returned to the operating room; one for cicatrix creating secondary ulnar nerve compression with motor weakness and one for residual bone fragment causing recurrent ulnar sided pain.
Conclusions: Acute/subacute surgical excision of hook of hamate fractures is a reliable option in elite baseball players to alleviate pain limiting play and predictably facilitates return to play. Meticulous adherence to proper surgical technique is mandatory to avoid complications and optimize clinical outcomes.
Level of Evidence - Therapeutic Level 5 V
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