Return to Play After Hook of Hamate Excision in Baseball Players: A Systematic Review

Abstract

Background:

Hook of hamate fractures are relatively common injuries in baseball players, often occurring during batting due to repetitive contact between the bat handle and the hypothenar region. Excision of the fractured hook is frequently performed in athletes for whom nonoperative treatment fails or who require expedited return to sport.

Purpose:

To evaluate return-to-play (RTP) rates, time to RTP, and postoperative complications and reoperation rates after hook of hamate excision in baseball players.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic search of 5 databases was performed to identify studies reporting clinical outcomes and complications after hook of hamate excision in baseball players. Extracted variables included patient characteristics, level of play, time from injury to surgery, RTP rate, time to RTP, complications, and reoperations. Overall outcomes and outcomes stratified by level of performance were analyzed. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria.

Results:

Ten studies consisting of 624 athletes were included. RTP ranged from 81% to 100%, with a weighted mean of 90.7%. The median RTP time was 5.7 weeks. The weighted RTP rate for professional athletes was 88.1%, with a weighted mean RTP time of 7 weeks. In nonprofessional and mixed-level cohorts, the weighted RTP rate was 98.2%, with a weighted mean RTP time of 5.3 weeks. A total of 43 (11.8%) complications were reported, most of them consisting of transient ulnar nerve symptoms or scar-related pain. Three (0.5%) athletes underwent reoperation.

Conclusion:

Hook of hamate excision in baseball players is associated with high RTP rates and short RTP time, typically occurring between 5 and 7 weeks after surgery. Postoperative complications are infrequent and generally minor and temporary, and reoperations are rare.