Hand clinics
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Osseous injuries to the ulnar aspect of the carpus are increasing in frequency because of greater participation in sporting activities. Hamate body fractures are subdivided into coronal, sagittal oblique, proximal pole, and medial tuberosity fractures. ⋯ Displaced hamate hook fractures are optimally treated with early excision to avoid sequelae such as flexor tendon and nerve injury, and to allow early return to activity. Undisplaced pisiform fractures are managed nonoperatively, whereas displaced fractures and nonunions are treated by simple excision.
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Nonsurgical management is the preferred treatment of stable, extra-articular fractures of the proximal and middle phalanx, most distal phalanx fractures, and, rarely, nondisplaced intraarticular fractures in elite athletes. Techniques that afford maximal strength with minimal dissection, thus allowing earlier return to play, are ideal. Open reduction with internal fixation with plate fixation is most often chosen for unstable phalangeal shaft fractures in high-demand athletes to provide rigid internal fixation and allow immediate range of motion and more rapid return to sport. It is our practice to routinely treat unicondylar fractures with surgery with percutaneous headless compression screws in elite athletes.
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Treatment of professional baseball players with PIP injuries requires careful evaluation and prompt treatment. Stability of the injury dictates treatment and return to play. The majority of injuries can be managed with minimal splinting or buddy taping, but the most complex injuries require operative intervention to ensure stable reduction. Consideration of players' position and handedness is important in determining return to practice and play.