Reconstruction of unstable dorsal PIP fracture-dislocations with hemi-hamate autografts: Clinical experience and results

Abstract

Aim: In this study, we evaluated the results of unstable dorsal proximal interphalangeal (PIP) fracture-dislocations reconstructed with hemi-hamate osteoarticular autografts.Methods: The hemi-hamate osteoarticular bone autograft reconstruction process was applied in 11 cases with unstablePIP fracture-dislocations which were not repairable using primary surgical techniques. After the base of the fractured phalanx was prepared, a graft was taken from the dorsal and osteoarticular surface of the hamate, inserted, and fixed withmini-screws. Preoperative radiologic imaging studies revealed middle phalanx volar lip involvement of 50% (interval: 40%-60%). Mean surgical delay was 4.9 weeks (interval: 3-8 w). PIP range of motion, contracture, stability, and pain visual analogscale (VAS) were recorded at a mean follow-up of 30 months. Graft position, collapse, and degeneration were evaluatedusing radiologic techniques.Results: The average range of motion angle was 86° (interval: 80°-100°). Flexion contracture was 10° (interval: 0°-20°). Inthe follow-up at 30 months, total union of the graft was achieved and confirmed by radiologic studies. Volar side collapsewas identified in 3 of 11 patients; however, no instability occurred. Mean pain VAS at follow-up was 0.27 (interval: 0-1). At amean follow-up of 30 months, all patients were subjectively satisfied with the procedure outcome and had returned to work.Conclusion: This study confirmed that the articular surface of the middle phalanx can be reconstructed using the propersurgical technique. Even with mild extension loss, functional range of motion is protected. Possible graft collapse can bedetected at follow-up. To avoid graft instability, the volar plate must be repaired to minimize the risk of complications andensure that excellent functional results are obtained.