title: Hemi-hamate autograft arthroplasty for acute and chronic PIP joint fracture dislocations.
abstract: BACKGROUND
  Treatment of fracture dislocations of the PIP joint represents a hand surgical challenge. In hemi-hamate arthroplasty, the palmar joint surface is reconstructed using an osteochondral graft from the hamate and the immediate stability permits early movement.
  
  
  METHODS
  We performed hemi-hamate reconstructions in 10 patients (mean age 34.9 years), who sustained fractures of the base of the middle phalanx of ≥50% surface and dorsal PIP dislocations. Outcomes were assessed by clinical exam and X-ray. Evaluation criteria were range of motion of PIP and DIP joints, grip strength, joint alignment, complications and donor site morbidity. Mean follow-up was 8.6 months (range 3-14). Fractures mostly involved the 4th and 5th fingers, all patients were male. Indications were subluxation and comminuition in acute cases of <6 weeks (5 patients) and chronic pain and morning stiffness in chronic cases (5 patients).
  
  
  RESULTS
  Operative treatment was performed in average after 93 days (range 0-371 days) after injury. Average PIP motion was 71° (range 0-90); DIP motion was 54° (range 10-90) with a mean PIP flexion contracture of 6.5° (range 0-20). Grip strength averaged 95% of the opposite hand. 4 patients had revision surgery (2× arthrolysis PIP joint, 2× screw shortening, 1× neurolysis R. dorsalis N. ulnaris).
  
  
  CONCLUSIONS
  Hemi-hamate autograft arthroplasty represents an effective procedure to address severe PIP joint fracture dislocations. It restores the comminuted articular surface in chronic injuries and in the acute injury it is a challenging but valuable alternative to extension block splinting. However, donor site morbidity and revision surgery have to be taken into account.
authors.affiliation: Department of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland. niclindenblatt@hotmail.com
authors.forename: N
authors.initials: N
authors.lastname: Lindenblatt
authors.forename: A
authors.initials: A
authors.lastname: Biraima
authors.forename: I
authors.initials: I
authors.lastname: Tami
authors.forename: P
authors.initials: P
authors.lastname: Giovanoli
authors.forename: M
authors.initials: M
authors.lastname: Calcagni
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D005384:Finger Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000502:physiology; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies