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.

Material and 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 4^th and 5^th 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.

Zusammenfassung

Hintergrund:

 Die Behandlung von Luxationsfrakturen des PIP-Gelenkes stellt weiterhin eine Herausforderung in der Handchirurgie dar. Bei der Hemihamatum-Arthroplastik wird die palmare Gelenkfläche mit einem osteochondralen Transplantat vom Os hamatum rekonstruiert, welches sofortige Stabilität und frühe Bewegung ermöglicht.

Patienten und Methoden:

 In unserer Abteilung wurden 10 Patienten mit Frakturen der Basis der Mittelphalanx mit mehr als 50% Gelenkflächenbeteiligung und dorsaler Luxation des PIP-Gelenkes mittels der Hemihamatum-Arthroplastik versorgt (Durchschnittsaltealter: 34,9 Jahre). Die Resultate wurden durch klinische Untersuchung und Röntgenbilder untersucht. Auswertungs­kriterien waren aktiver Bewegungsumfang der PIP- und DIP-Gelenke, Greifkraft, Gelenkkongruenz, Komplikationen und Morbidität an der Entnahmestelle. Der mittlere Nachuntersuchungszeitraum betrug 8,6 Monate (Spanne 3-14 Monate). Am häufigsten waren der 4. und 5. Finger betroffen, alle Patienten waren männlich. Indikationen zur Operation waren Subluxation und Zerstörung der Gelenkfläche in akuten Fällen < 6 Wochen nach Trauma (5 Patienten) und chronische Schmerzen und Morgensteifigkeit in chronischen Fällen > 6 Wochen nach Trauma (5 Patienten).

Ergebnisse:

 Die operative Versorgung erfolgte im Durchschnitt nach 93 Tagen (Spanne 0–371 Tage). Der durchschnittliche aktive Bewegungs­umfang des PIP-Gelenkes betrug 71° (Spanne 0–90°); die DIP-Beweglichkeit war 54° (Spanne 10–90°) bei einer durchschnittlichen PIP-Flexionskontraktur von 6.5° (Spanne 0–20°). Die Greifkraft betrug im Durchschnitt 95% der Gegenseite. Bei 4 Patienten wurden Revisions­eingriffe durchgeführt (2×Arthrolyse PIP-Gelenk; 2×Schraubenkürzung; 1×Neurolyse R. dorsalis N. ulnaris).

Schlussfolgerung:

Die Hemihamatum-Arthroplastik stellt eine effektive Prozedur dar, um dislozierte PIP-Gelenkfrakturen zu behandeln. Sie stellt die zerstörte PIP-Gelenkfläche in chronischen Verletzungen wieder her und ist eine wertvolle Alternative zur Extensionsblockschienung in akuten Verletzungen. Eventuelle Revisionseingriffe und die Morbidität an der Entnahmestelle sollten mitbedacht werden.

Key words

PIP joint - fracture dislocation - hamate - arthroplasty - autograft

Schlüsselwörter

PIP-Gelenk - Luxationsfraktur - Hamatum - Arthroplastik - Autograft

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