Abstract
Objectives:
In an analysis of injuries across professional baseball from 2011-2016, there were 4,478 hand injuries reported, resulting in 67,036 days missed. Fractures of the hand are significant injuries that often require surgical intervention, especially those of the phalanx. However, post-injury performance metrics after both operative and nonperative treatment of hand fractures have not been previously analyzed. Therefore, the purpose of this study was to report the demographics, time until return to sport (RTS), and offensive performance outcomes in professional baseball players with various hand fractures.
Methods:
The Major League Baseball (MLB) Health and Injury Tracking System (HITS) database was utilized to identify MLB and Minor League Baseball (MiLB) players who were diagnosed with a hand fracture from 2011-2022. The HITS database provided data reported by the player’s sports medicine staff regarding mechanism/timing of injury, which specific joint was affected, whether operative or nonoperative treatment was pursued, the time until RTS, and offensive performance statistics. Hand fractures not related to baseball were excluded, and pitchers were excluded from the offensive performance analysis. Performance data was grouped into pre-injury (1 year prior to injury date) as well as various post-RTS time points, and performance data regarding operative vs. nonoperative treatment and player position (infielder, outfielder, catcher) was isolated.
Results:
Overall, 878 professional baseball players experienced a hand fracture over the 12-year study period. The majority of players were infielders (40%) or outfielders (30%), and the metacarpal was the most commonly affected joint (50%) (Table 1). Players returned to sport at a mean of 58±46 days after injury. There were 177 (20%) players who required operative treatment, and these players returned to sport later than players who underwent nonoperative treatment (85 days vs. 51 days, p<0.001) (Table 2). Rates of operative treatment and time until RTS did not differ based on player position (p>0.05). Joint fractured did not significantly affect time until RTS in players treated operatively, however in players treated nonoperatively fractures of the metacarpal took the longest time until RTS (63 days) while fractures of the distal phalanx took the shortest time (31 days). Position players experienced a significant drop in batting average, on-base percentage (OBP), slugging percentage (SLG), and on-base plus slugging percentage (OPS) (Table 3), and this pattern was similar when isolating performance outcomes between players who received non-operative and operative treatment. While catchers experienced the most significant loss of offensive performance, infielders and outfielders also experienced a significant drop in OPS that improved over time, but did not return to baseline, up to 1 year after hand fracture (Figure 1).
Conclusions:
Following hand fracture, professional baseball players were able to RTS in about two months after nonoperative treatment and in about three months after operative treatment. While player position did not affect time until RTS and rates of operative treatment, player position did affect offensive performance upon RTS, with catchers experiencing the most significant loss of offensive performance. Clinicians should consider the joint affected, treatment plan, and position of the player when planning a RTS timeline and when discussing performance expectations after RTS.
