Hemi-Hamate Autograft for the Treatment of Unstable Dorsal Fracture Dislocation of the Proximal Interphalangeal Joint

Background Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex operations. In this review, the current concepts surrounding the managment of these injuries are reviewed. Methods A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles, or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. Results When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none have been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. Conclusion The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than non-congruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible.

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“…This operation continues to evolve, with several helpful modifications and pearls available in recent technique articles. 60,62 …”

Section: Dorsal Fracture-dislocationmentioning

confidence: 99%

Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

Haase

Chung

2014

Plastic and Reconstructive Surgery

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“…4,7,12e16,20,21 Nearly all of the series using VPA were published more than 10 years ago and more recent reports demonstrate enthusiasm for performing hemi-hamate reconstructions. 4,7,13,14,16,20,21 No clear guidelines exist regarding which of these accepted treatments may be more appropriate given the characteristics of the injury. Our biomechanical data show that both VPA and hemi-hamate reconstructive options prevent dorsal subluxation of the middle phalanx, effectively restoring a concentric PIP joint.…”

Section: Discussionmentioning

confidence: 99%

“…16 Furthermore, these purported advantages of HHA in comparison with VPA may increase with an increasing defect size, because VPA may induce a greater flexion contracture as the volar plate is advanced farther into a larger defect. The published series on either of these reconstructive options do not typically characterize the size of the defects being reconstructed, however, and this remains a theoretical advantage of HHA.…”

mentioning

confidence: 99%

Biomechanical Characteristics of Hemi-Hamate Reconstruction Versus Volar Plate Arthroplasty in the Treatment of Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint

Tyser

Tsai

Parks

et al. 2015

The Journal of Hand Surgery

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“…6,7,9 It has become an accepted technique for the treatment of dorsal fracture-dislocations of the PIP joint with comminuted volar base of the P2. Morphological and mechanical studies have demonstrated its suitability for these reconstructions.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Use of the dorsal portion of the hamate to reconstruct the volar segment of the base of the P2 (so-called hemicondylar hamate replacement arthroplasty) has become a popular technique, with good mid-term results. [7][8][9] Using the same principle, but expanding the anatomical basis, the authors investigated the suitability of the reciprocal articular surfaces-that is, use of the base of the little finger metacarpal (M5) as an osteochondral graft for reconstruction of the condyles of the P1 in an anatomical study and a clinical series, to determine whether the concept was anatomically sound and clinically achievable.…”

mentioning

confidence: 99%

Reconstruction of the Condyles of the Proximal Phalanx With Osteochondral Grafts From the Ulnar Base of the Little Finger Metacarpal

Cavadas¹,

Landín²,

Thioné³

2010

The Journal of Hand Surgery

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Hemi-Hamate Autograft for the Treatment of Unstable Dorsal Fracture Dislocation of the Proximal Interphalangeal Joint

Cited by 43 publications

References 6 publications

Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

Biomechanical Characteristics of Hemi-Hamate Reconstruction Versus Volar Plate Arthroplasty in the Treatment of Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint

Reconstruction of the Condyles of the Proximal Phalanx With Osteochondral Grafts From the Ulnar Base of the Little Finger Metacarpal

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