Hemi-hamate osteochondral transplantation in proximal interphalangeal dorsal fracture dislocations: a minimum 4 year follow-up in eight patients

Abstract

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.

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

“…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.…”

A simple pre-operative imaging method to assess donor and recipient anatomy in hemi-hamate arthroplasty for proximal interphalangeal joint reconstruction

“…The most notable issue with this procedure is the high rate of post-traumatic arthritis found at the reconstructed PIP joints at long-term follow up [1,2]. Despite these findings, no report has rigorously studied the factors associated with successful grafts compared to those that develop posttraumatic joint disease.…”

“…HHA is a complex surgical technique that is associated with highly-variable surgical outcomes [1,2,7,8,13,14]. The most notable issue with this procedure is the high rate of post-traumatic arthritis found at the reconstructed PIP joints at long-term follow up [1,2].…”

Traitement d’une fracture luxation chronique de l’interphalangienne proximale par un greffon d’hémi-hamatum

“…Les conditions requises pour une reconstruction réussie de l'interphalangienne proximale comprennent, la restitution d'une surface articulaire anatomique proche de la base de la deuxième phalange et une stabilité ostéoligamentaire. Une partie de l'hamatum au niveau de l'interligne carpo-métacarpien remplit ce cahier des charges et a été utilisé comme greffon dans les fractures-luxations à la fois aiguës et chroniques [2][3][4][5][6]. Nous rapportons ici notre expérience sur un cas de fracture luxation chronique de linterphalangienne proximale traitée par greffon libre d'hémi-hamatum et les résultats cliniques et radiologiques à 1 an de recul.…”