Hemi-hamate Arthroplasty for Base of Middle Phalanx Fracture: A Systematic Review

Abstract

Intra-articular fracture dislocations of the base of the middle phalanx are complex and debilitating injuries that present a management conundrum when nonreconstructable. Hemi-hamate arthroplasty (HHA) is a treatment modality of particular use in the setting of highly comminuted fractures. This systematic review aims to summarize the reported outcomes of HHA in this context. A literature search was conducted using MEDLINE, Embase, and PubMed, yielding 22 studies with 235 patients for inclusion. The weighted mean postoperative range of movement at the proximal interphalangeal joint was 74.3° (range, 62.0°-96.0°) and at the distal interphalangeal joint was 57.0° (range, 14.0°-80.4°). The weighted mean postoperative pain Visual Analog Scale was 1.0 (range, 0.0-2.0). The weighted mean postoperative grip strength was 87.1% (range, 74.5%-95.0%) of the strength on the contralateral side. Posttraumatic arthritis was reported in 18% of cases, graft collapse in 4.2%, and donor site morbidity in 3.0%, with a mean follow-up period of 28.4 months (range, 1-87 months). Hemi-hamate arthroplasty is a reliable and effective technique for the reconstruction of intra-articular base of middle phalangeal fracture dislocations, affording symptomatic relief and functional restoration. Further research is required to assess the true incidence of long-term complications.

Hemihamate Arthroplasty Revisited

“…Verdins et al 9 reported 2 of 11 patients who developed arthrosis of the PIPJ within 6 months of HHA and ultimately required a synthetic joint replacement. Although Calfee et al 13 reported loss of joint space in 43% of patients based on postoperative radiographic evaluation, these findings did not correlate with poorer 11 reported posttraumatic arthritis in 18% of cases. In addition, 12 studies found the weighted mean postoperation pain to be 1.0 (range, 0-2.0) using visual analog scale.…”

“…[8][9][10]13,14,[17][18][19] The majority of these studies (4 of 7) report between 63 and 69 degrees arc of motion, similar to the average postoperative arc of motion (63 degrees) reported in our series (Table 4). Two systematic reviews reported an average postoperative PIPJ motion of 77 degrees (Frueh et al 4 ) and 74 degrees (Faulkner et al 11 ). The mean time to follow-up was 26 months in the current series, which is comparable to that reported in the literature.…”

“…Although Calfee et al 13 reported loss of joint space in 43% of patients based on postoperative radiographic evaluation, these findings did not correlate with poorer outcomes. In a systematic review of 22 studies with 235 patients, Faulkner et al 11 reported posttraumatic arthritis in 18% of cases. In addition, 12 studies found the weighted mean postoperation pain to be 1.0 (range, 0–2.0) using visual analog scale 11 .…”

“…The average postoperative PIPJ arc of motion reported after HHA ranges from 63 to 90 degrees. 4,[7][8][9][10][11][12][13][14][15][16][17][18][19] The procedure is described in the literature as technically demanding, and diagrams elude to the need for accurate measurements and angles. 7,12,13,16 Despite case series describing good outcomes with HHA, it has not gained widespread use in unstable PIPJ fracture dislocations.…”

“…Since the initial description of the HHA, case series, retrospective reviews, and 2 systematic reviews have been published on the topic reporting significant improvements in PIPJ range of motion. The average postoperative PIPJ arc of motion reported after HHA ranges from 63 to 90 degrees 4,7–19 . The procedure is described in the literature as technically demanding, and diagrams elude to the need for accurate measurements and angles 7,12,13,16 .…”