Clinical Results of Excision of Hamate Hook in the Baseball Players with Hamate Hook Nonunion

Seoung-Joon Lee; Jong-Soo Lee

doi:10.12671/jkfs.2016.29.1.12

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Lee and Lee: Clinical Results of Excision of Hamate Hook in the Baseball Players with Hamate Hook Nonunion

Original Article

Journal of the Korean Fracture Society 2016; 29(1): 12-18.

Published online: 19 January 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.1.12

Clinical Results of Excision of Hamate Hook in the Baseball Players with Hamate Hook Nonunion

Seoung-Joon Lee, M.D., Ph.D., Jong-Soo Lee, M.D.

Department of Orthopaedic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.

Address reprint requests to: Seoung-Joon Lee, M.D., Ph.D. Department of Orthopaedic Surgery, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea. Tel: 82-2-2030-7616, Fax: 82-2-2030-7369, lsjmd@naver.com

Received 3 July 2015 Revised 26 July 2015 Accepted 30 October 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study is to report the clinical results of excision of the hamate hook in baseball players with hamate hook nonunion.

Materials and Methods

This study included 10 baseball players treated with excision of the hamate hook. Among 10 players, there were 3 professional players and 7 amateur players. The clinical outcomes were evaluated using the visual analog scale (VAS) pain score, exercise performance score, and grip power. We also checked complications and time to return to the game.

Results

At final follow-up, the average VAS score was 0.4 points and the average performance score was 9.0 points. The grip power was recovered to 96.7% of the opposite hand at final follow-up. Significant improvement in pain and grip power was observed after surgery. The average time to return to the game was 11.8 weeks. There was one case of postoperative ulnar nerve neuropathy, which was completely resolved within 12 weeks after surgery.

Conclusion

We think that excision of the hamate hook is an effective treatment to enable early return to the game without loss of grip strength in the baseball player with nonunion of the hamate hook.

Keywords: Hook of the hamate, Nonunion, Excision

Figures and Tables

Fig. 1

(A) Classification of hamate hook fractures. Number in parenthesis indicates number of patients. (B) Computed tomography-axial view shows nonunion of a hamate hook fracture (arrow).

Fig. 2

(A) A curved skin incision was made on the hypothenar eminence (asterisk: hamate hook). (B) After careful retraction of the superficial branch of the ulnar nerve (dashed arrow) ulnarly, the hamate hook (asterisk) and the deep branch of the ulnar nerve (arrow) can be found. (C) The hamate hook was removed carefully.

Fig. 3

The grip power was recovered to 96.7% of the opposite hand at the final follow-up. POD: Postoperative day.

Fig. 4

Location of the hamate hook relative to a bat end in the nondominant right hand of a left-handed hitter. H: Hamate hook, P: Pisform.

Table 1

Patients' Data

Patient No.	Age (yr)	Injured hand	P/A	Time to diagnosis (mo)	Tingling of little finger
1	17	Nondominant	A	10	-
2	18	Nondominant	A	6	-
3	18	Nondominant	A	8	-
4	20	Nondominant	A	4	-
5	22	Nondominant	P	6	-
6	25	Nondominant	P	4	-
7	21	Nondominant	P	6	-
8	18	Nondominant	A	10	+
9	18	Nondominant	A	12	-
10	19	Nondominant	A	6	-

P: Professional, A: Amateur.

Table 2

Clinical Outcomes after Excision the of Hamate Hook

	VAS score		Performance score		Return to game (wk)	Grip power (lb)			POD-UN
	Preop	Final	Preop	Final	Return to game (wk)	Opposite	Preop	Final	POD-UN
Patient No.
1	7	0	4	9	10	70	50	75	−
2	6	1	3	8	12	110	70	110	−
3	8	0	2	10	16	90	20	90	+
4	6	0	4	9	12	105	95	95	−
5	5	0	5	9	10	100	80	90	−
6	7	1	3	9	8	110	80	100	−
7	8	2	2	10	10	90	60	90	−
8	10	0	1	10	12	110	70	100	−
9	6	1	2	9	16	100	90	105	−
10	9	0	4	10	12	100	70	90	−
Mean±standard deviation	7.1±1.4	0.4±0.6	3.0±1.1	9.0±0.7	12±2.6	96.9±12.3	66.9±22.4	93.6±9.4
p-value	<0.05		<0.05			<0.05

VAS: Visual analog scale, POD-UN: Postoperative day ulnar neuropathy, Preop: Preoperative.

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