PAPER 14: Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play

OBJECTIVES: Hook of hamate fractures are relatively common in baseball players, but diagnosis and surgical technique can be challenging. Outcomes following surgical excision, as well as optimal surgical technique, in elite baseball players have not been clearly established. Our hypothesis was that excision of hook of hamate fractures in elite professional and collegiate baseball players with a tailored technique would lead to high rates of return to play within a short time. METHODS: eview of a single academic hand surgery practice from 2006-2020 found 42 elite athletes competing at professional (20) or varsity collegiate (22) baseball levels who underwent surgical excision of 42 hook of hamate fractures with a standardized technique. The clinical history, timing of surgery, complications, and time to return to play were recorded for each patient. RESULTS: All patients underwent an excision of their hook of hamate fracture at an average of 7.2 weeks (range 0.5 – 52 weeks) from the onset of symptoms. All patients but one were able to return to full pre-injury level of baseball participation within 6 weeks from the date of surgery, with a mean return to sport of 5.4 weeks (range 3-8 weeks). Two patients returned to the operating room – one for scar tissue formation causing ulnar nerve compression and one for residual bone fragment causing pain and ulnar nerve compression. CONCLUSIONS: Surgical excision of hook of hamate fractures in elite baseball players showed a very high rate of return to play within six weeks. Meticulous adherence to the described surgical technique tailored to athletes optimizes clinical outcomes and avoids complications.