Simple and Reproducible Hemi-Hamate Arthroplasty Technique: A Retrospective Review
Veronique M. Doucet, MEng, MD, Tod A. Clark, MD, MSc, FRCSC and Jennifer L. Giuffre, MD, FRCSC, University of Manitoba, Winnipeg, MB, Canada
Proximal interphalangeal joint (PIPJ) fracture dislocations are complex injuries which can result in persistent pain, stiffness, and angulation. Hemi-hamate arthroplasty (HHA) can be used to reconstruct the base of the middle phalanx in cases of unstable PIPJ fracture dislocations. In the literature, the procedure is described as technically demanding due to the need for accurate measurements and angles. Despite previous case series describing good outcomes with HHA, it has not gained widespread use. The purpose of this study is to describe our straight-forward and reproducible technique and to demonstrate the benefit in motion following the procedure.
Materials & Methods
All patients with unstable PIPJ fracture dislocations requiring resurfacing of greater than 40% of the base of the middle phalanx treated with HHA were retrospectively reviewed. Patient demographics, injury features, surgical technique, pre- and post-operative PIPJ range of motion and arc of motion, time to surgery, and complications were reviewed. Any fracture amenable to fixation or cases with radiographic evidence of arthritis or injury to the head of the proximal phalanx were excluded.
Key points of the surgery include: debriding all fracture fragments, osteophytes and callous to ensure the joint is reducible prior to arthroplasty; assessing the orientation of the intermetacarpal articular ridge on the hamate to ensure that the hamate osteotomy aligns the interarticular ridge of the hamate with the interarticular ridge of the middle phalanx base, making an oblique hamate osteotomy if necessary to align the interarticular ridges; taking a larger bone block than required; and fixating the bone graft with two bicortical screws to restore the volar buttress. 11 cases were reviewed. Mean patient age was 35. Mean time from injury to surgery was 6 months. Mean joint surface involved was 64%. Mean PIP joint arc of motion was 17° pre-operatively and 63°post-operatively. Mean bone block size required was 8 x 8 x 8 mm. Mean follow up was 26 months. Post-operative pain at the PIP joint on visual analogue scale was 0.4 (scale of 0 to 10). Complications included 2 patients requiring tenolysis.
Despite the lack of a perfect geometric recreation of the base of the middle phalanx with the hamate, patients recovered acceptable PIPJ motion and had minimal pain. HHA is a good option for any patient with minimal motion of their PIPJ following an unstable fracture dislocation.
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