Outcomes of Hemi-Hamate Arthroplasty for Proximal Interphalangeal Joint Reconstruction.

Abstract

Background: Hemi-hamate arthroplasty (HHA) is a reconstructive option for the proximal interphalangeal joint (PIP) following fracture-dislocation injuries. This study reports outcomes following HHA, including PIP and distal interphalangeal (DIP) joint range of motion (ROM), complications, and need for revision surgery with intermediate term follow-up.

Methods: Thirty-five patients following HHA were included over a 12-year period from two fellowship-trained surgeons at a single institution. The primary outcome included postoperative PIP and DIP (ROM). The secondary outcome included complications and a need for a revision surgery.

Results: Preoperative PIP ROM averaged 14° in arc of motion (14° extension, range: 0°-39°, 28° flexion, range: 0°-71°). Postoperative PIP ROM averaged a 62° arc of motion (20° extension, range: 0°-60°, 82° flexion, range: 25°-100°). Distal interphalangeal extension was 3° and 2° preoperatively and postoperatively, respectively. The average follow-up duration was 6 months (range: 2-26 months). Three patients underwent secondary HHA following open reduction internal fixation or volar plate arthroplasty; postoperative PIP average extension-flexion motion resulted in 30° and 65°, respectively (range: 14°-50°, 30°-85°). Flexion stiffness was the most common complication, with eight patients undergoing flexor tenolysis following the index procedure. One patient had graft resorption, and one had mild degenerative joint changes at the time of final follow-up. No patients required a revision surgery or demonstrated persistent joint instability.

Conclusions: Hemi-hamate arthroplasty for reconstruction of the volar margin of the middle phalanx following fracture-dislocations leads to functional PIP and DIP ROM. Patients undergoing secondary HHA had reduced PIP ROM compared to the primary cohort. No patient required a revision surgery or demonstrated persistent instability with intermediate follow-up.