Fracture dislocations of the PIP joint are challenging to treat. In hemi-hamate arthroplasty, the palmar lip joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement. In the long term, collapse of non-vascularized osteochondral grafts might lead to degenerative arthritis. We examined the radiographic result after a minimum of 4 years with special reference to the development of osteoarthritis and its relation to clinical symptoms in eight patients, mean age 49 (25-66) years. After a mean of 60 (48-69) months, the arc of motion was 67° (45°-95°) at the PIP joint and grip strength was 91% of the uninjured side. The visual analogue score for pain (0-100) was 10 (0-70) mm. Severe arthritis (grade IV) was found in two and mild arthritis (grade II) in another two patients, but only one of these four cases had troublesome pain. The hemi-hamate technique is an attractive alternative to other treatment options, but some cases develop osteoarthritis in the medium term.

In the past, the attitude toward surgical repair of sciatic and peroneal nerve lesions was excessively pessimistic. Refinements of microsurgical technique, nerve conduction studies, and the establishment of indications and optimal timings for surgical interventions have led to significant improvements in outcomes, making repair worthwhile in most cases. Tendon transfers can augment functional outcomes, and are performed as secondary procedures or (in selected cases) in combination with the initial repair. Developments in the basic sciences, bioengineering, and medical imaging may further improve the results of management of these serious nerve injuries.

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