Hemi-hamate Arthroplasty in Chronic Fracture-dislocation of Proximal Interphalangeal Joint of Fingers: A Report of Two Cases

Abstract

Dorsal dislocations of proximal interphalangeal joint with palmar lip fractures base of middle phalanx of fingers are rare, complex, and often a challenging injury to the treating hand surgeons especially in those chronic cases. Hemi-hamate arthroplasty is the preferred surgical option in treating chronic dorsal fracture-dislocations of the proximal interphalangeal joint. We report two cases with a chronic injury that have been treated with hemi-hamate arthroplasty. Range of motion, pinch and grip strengths, QuickDASH scores, complications, and radiological findings were recorded at follow-up. Good functional outcomes were observed in both patients without major complications. Hemi-hamate arthroplasty can be a reliable surgical treatment for chronic proximal interphalangeal joint fracture-dislocations.

Hemihamate Arthroplasty Revisited

“…Hemihamate arthroplasty is a treatment option for unstable chronic dorsal fracture-dislocations of the PIPJ. The literature reports a 63 to 90 degrees arc of motion in patients who have undergone a HHA 8–10,13,14,17–19 . 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).…”

“…The literature reports a 63 to 90 degrees arc of motion in patients who have undergone a HHA. [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 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 .…”

Neglected Dorsal Proximal Interphalangeal Joint Dislocation Treated by Volar Plate Arthroplasty: A Case Series

“…Open reduction is recommended and fractured fragments can be fixed with 1.5 or 2.0 mm screws or a min fragment buttress plate over a volar plate area to reduce comminuted fragments [ 12 ]. When the fractured fragments with the attached volar plate are not amenable for osteosynthesis, reconstruction of the volar plate by VPA [ 3 ] or hook of the hamate graft [ 11 , 13 , 14 ] reconstruction of the base of middle phalanx is the standard of care. Tenodesis with FDS and arthrodesis of PIP joint were reported by few authors in the literature [ 15 ].…”