Reverse Hemi-Hamate Arthroplasty in Chronic Volar Proximal Interphalangeal Joint Fracture Dislocation A Case Report
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Abstract
Fracture-dislocations of the proximal interphalangeal joints (PIPJ) are uncommon and complex injuries that are often overlooked. These cases often present with a dorsal dislocation, but a subset of patients present with a volar dislocation and fracture of the dorsal lip of the middle phalanx. In reported cases, functional outcomes are poor following traditional open reduction and internal fixation due to persistent limited range of motion. Hemi-hamate arthroplasty is a relatively new technique introduced in 2002, involving an osteochondral graft to reconstruct the deficient base of the middle phalanx. It affords immediate stability to the joint and earlier range of motion, resulting in less joint stiffness.
A 16-year-old male presented with a three-month history of a volar fracture-dislocation of the left ring finger and had a fixed 60º flexion deformity of the PIPJ and limited range of motion at the distal interphalangeal joint (20–70º range of motion). Patient underwent reverse hemi-hamate arthroplasty (rHHA) using two 1.5 mm cortical screws and was placed in a volar splint for six weeks. At seven months post op, PIPJ and DIPJ active range of motion were 0–90º and 0–75º, respectively. Grip strength was 22% weaker than the unaffected hand (32 kg).
Reverse hemi-hamate arthroplasty is an excellent option for patients with chronic volar PIPJ fracture dislocations with favorable outcomes and return to function while having minimal donor site morbidity.
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