Treatment of PIP joint fracture-dislocations with Hemi-hamate Arthroplasty

June 1st, 2007

When you sustain a PIP joint dislocation, the volar rim of the middle phalanx--P-2--may fracture. If it is a small percentage of the bone, on the lateral xray, early range of motion with the use of a splint to limit extension, may be an option----since the collateral ligaments are still attached to the base of P-2. However, if the joint is unstable because of the size of the bone piece, and if the piece is more than 50% of the joint surface, few options exist for reconstruction.

Hemi-hamate arthroplasty was introduced in the 1990's to solve this complex problem--and the literature, as well as my own experience with the procedure, have shown how valuable it is. A small piece of hamate bone is used to restore the volar lip of P-2, effectively restoring PIP joint stability and enabling range of motion. Though full range is unlikely, functional flexion to 75-80 degrees is expected.

Related Photos:

Preoperative PA xray following PIP joint fracture dislocation

Preoperative lateral xray shows significant percentage of articular involvement and comminution, contraindicating orif and volar plate arthroplasty

Intraoperative photo shows the articular damage to the volar portion of the base of P-2

Base of P-2 is prepared to acept hemihamate articular graft

The recipient site dimensions are recorded to facilitate accurate donor site harvest

Hemihamate graft

Intraoperative photo of hemihamate graft in place

Additional view of hemihamate graft in place

PIP joint is reduced

Intraoperative flexion

Intraoperative extension

Postoperative PA xray

Postoperative lateral xray. It appears as though there is a step off between hemihamate and native P-2 articular cartilage because the cartilage on the hemihamate graft is thicker