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Hemihamate Autograft Reconstruction: Management of Complex Proximal Interphalangeal Joint Fracture-Dislocations

March 01, 2020

Contributors: Louis W Catalano III, MD, FAAOS; Kate Wilkins Nellans, MD, FAAOS; Devon J Ryan, MD; James R Mullen, MD

Keywords: Tendons

Proximal interphalangeal joint fracture-dislocations are common injuries. A dorsal dislocation with a volar lip fracture fragment is the most frequently observed fracture pattern. Surgical management is indicated for unstable injuries (often involving >50% of the articular surface) in which concentric joint reduction cannot be maintained, even with slight flexion of the digit. If a single, large volar fragment is present, surgical options include closed reduction and percutaneous pinning (transarticular or between the fragment and the middle phalanx), dynamic external fixation, or open reduction and internal fixation with the use of headless compression screws or a plate and screw construct. However, these fixation options may not be possible if considerable comminution is present. Reconstruction options include volar plate arthroplasty and hemihamate autograft resurfacing. This video presents two hemihamate resurfacing arthroplasty cases, one in an index finger and one in a little finger. The video includes preoperative imaging studies, a detailed description of the surgical technique, postoperative imaging studies, postoperative clinical video, and tips and tricks for successful outcomes. Hemihamate autograft resurfacing involves excision of comminuted volar fracture fragments and preparation of the site for a box-shaped graft. An appropriately sized portion of the distal articular surface of the hamate is then harvested, centered on the ridge between the fourth and fifth carpometacarpal joints, which ultimately re-creates the ridge in the articular surface of the base of the middle phalanx. The graft is sized to ensure adequate fit and then fixed with the use of two or three screws. After viewing this video, surgeons will have a good sense of the appropriate clinical scenario in which hemihamate autograft resurfacing is indicated and the steps required to effectively perform the procedure. Numerous studies discussing the surgical technique and outcomes have been published, confirming the utility of this procedure for the management of complex proximal interphalangeal fracture-dislocations.