Bansal Anchal, Carlan Douglas, Moley John, Goodson Heather, Goldfarb Charles A
Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes Jewish Hospital, St. Louis, MO.
Eaton Orthopedics, St. Petersburg, FL.
J Hand Surg Am. 2017 Oct;42(10):803-809. doi: 10.1016/j.jhsa.2017.06.108. Epub 2017 Aug 26.
The purpose of this study was to evaluate the efficacy of hook of the hamate excision for fracture in a large cohort of patients to better understand recovery time and complications.
We retrospectively reviewed the medical records of patients treated with surgical excision for hook of the hamate fractures at 2 different centers. We collected information on demographics, clinical presentation, and postoperative complications. Continuous outcome variables included time to surgery, return to play, and return to activity.
Our cohort of 81 patients had a median age of 22 years and was composed of 74 athletes including 57 baseball players and 8 golfers. The median time to return to play was 6 weeks (range, 1-36 weeks) after surgery; 11 patients (14%) had a return at 12 weeks or longer. Seventy-eight patients returned to preinjury activity levels. Twelve patients with a full recovery continued to experience some level of intermittent, nonspecific pain in the affected hand, although this was not severe enough to require additional treatment. We observed a 25% incidence of postoperative complications with the majority consisting of transient ulnar nerve dysfunction. Complications were more common among nonathletes, those presenting with nonunions, and those experiencing longer intervals between injury and surgery.
In most cases, surgical excision as treatment for hook of the hamate fractures is safe and allows a relatively rapid return to play. However, we found a higher incidence of complications, including transient ulnar nerve dysfunction, than has been previously reported. In addition, there is a group of patients with delayed return to play and continued discomfort after surgery. These findings should inform the discussion with surgical candidates.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
本研究旨在评估在一大群患者中进行钩骨切除术治疗骨折的疗效，以更好地了解恢复时间和并发症情况。
我们回顾性分析了在2个不同中心接受钩骨骨折手术切除治疗的患者的病历。我们收集了人口统计学、临床表现和术后并发症的信息。连续的结果变量包括手术时间、恢复运动时间和恢复活动时间。
我们的81例患者队列的中位年龄为22岁，其中包括74名运动员，其中57名棒球运动员和8名高尔夫球手。术后恢复运动的中位时间为6周（范围1 - 36周）；11例患者（14%）在12周或更长时间后恢复运动。78例患者恢复到受伤前的活动水平。12例完全康复的患者受影响的手仍持续存在一定程度的间歇性、非特异性疼痛，尽管疼痛程度不足以需要额外治疗。我们观察到术后并发症发生率为25%，大多数为短暂性尺神经功能障碍。并发症在非运动员、出现骨不连的患者以及受伤与手术间隔时间较长的患者中更为常见。
在大多数情况下，手术切除治疗钩骨骨折是安全的，并且能使患者相对较快地恢复运动。然而，我们发现并发症的发生率高于先前报道，包括短暂性尺神经功能障碍。此外，有一组患者术后恢复运动延迟且持续不适。这些发现应为与手术候选者的讨论提供参考。
研究类型/证据水平：治疗性IV级。
