J Korean Orthop Assoc.  2007 Aug;42(4):475-482. 10.4055/jkoa.2007.42.4.475.

Treatment of Unstable Dorsal Proximal InterphalangealFracture/Dislocation using a Hemi-Hamate Autograft

• Shin HD
• Kim KC
• Woo SM

• KMID: 2186509
• DOI: http://doi.org/10.4055/jkoa.2007.42.4.475

Abstract

PURPOSE: To evaluate clinical and radiology assessments of the treatment outcomes of an unstable dorsal proximal interphalangeal (PIP) fracture and dislocation by hemi-hamate autograft.
MATERIALS AND METHODS
Six patients underwent a hemi-hamate autograft for the treatment of an unstable dorsal PIP fracture dislocation of which the articular involvement of the PIP joint was >50%, or an unstable joint despite the lesser degree of involvement. The clinical results were evaluated from the following: postoperative patient satisfaction, range of motion, stability and grip strength. The radiographs were evaluated for the union, and graft incorporation, and/or collapse.
RESULTS
All patients were satisfied with the results and the range of motion of the PIP joint was 81 degrees (75-100 degrees). In all cases, stability of the PIP joint was restored. The average grip strength was 82% (75-90%) of the uninjured side. Bone union was achieved in all patients.
CONCLUSION
A hemi-hamate autograft is effective for reconstructing the cup-shaped contour of the articular surface, and for recovering the functional range of motion of the PIP joint after an unstable dorsal proximal interphalangeal (PIP) fracture and dislocation. However, more study will be needed through a mid-term and long-term follow up.

Keyword

Midphalanx; PIP joint; Fracture; Dislocation; Hemi-hamate autograft

MeSH Terms

Autografts*
Dislocations
Follow-Up Studies
Hand Strength
Humans
Joints
Patient Satisfaction
Range of Motion, Articular
Transplants

Figure

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  Fig. 1 Exposure was gained through a Bruner incision and the A3 pulley was released, the flexor tendons were pulled laterally, and the volar plate was released distally. The PIP joint was shotgunned open after the collateral ligaments were released.

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  Fig. 2 The operator measured the size of the middle phalangeal defect with a ruler.

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  Fig. 3 A schematic design of the distal hamate donor site and hamate with bases of the ring and small metacarpals exposed.

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  Fig. 4 Temporary fixation with K-wireis shown and the graft is held in place with a mini-screw.

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  Fig. 5 (A) A 22-year-old male, radiographs show a midphalangeal fracture with 50 % involvement of the articular surface. (B) Postoperative radiographs show a reduction of the PIP fracture and dislocation. (C) Last follow up (10 month) images shows complete union of the graft.

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  Fig. 6 (A) A 34-year-old male, preoperative radiographs shows midphalangeal fracture with 65% involvement of the articular surface. (B) Postoperative radiographs shows a reduction of the PIP fracture by 4 miniscrews. (C) Last follow up (11 month) images shows complete union of the graft.

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  Fig. 7 Gross photograph about the range of PIP joint motion.

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