Long-Term Clinical and Radiological Results of Hemi-Hamate Arthroplasty for Proximal Interphalangeal Fracture Dislocation.

Abstract

This study aimed to assess the long-term clinical and radiologic results after hemi-hamate arthroplasty in patients with acute or chronic irreparable fractures of the base of the middle phalanx. Between 2010 and 2014, hemi-hamate arthroplasties were performed on 12 patients with a mean age of 29.5 (SD 4.9) years. The patients included acute cases (treated within 6 weeks of the fracture) and chronic cases (treated after 6 weeks). We assessed the cases at a mean follow-up of 10.7 years. We recorded visual analog scale (VAS) scores, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, Patient-Rated Wrist Evaluation (PRWE) scores, grip and pinch strengths, proximal interphalangeal (PIP) joint range of motion (ROM), and radiologic findings. The results were compared with those from the opposite hand. The mean active ROM of the PIP joint was 76.6ᵒ (SD 34.2). Patients lost an average of 6.7ᵒ of extension and 17.5ᵒ of flexion compared to the comparable joint in the healthy hand. The mean scores for VAS, QuickDASH, and PRWE were 1, 12.7, and 7.6, respectively. The presence of osteoarthritis, which was observed in 7 of 12 patients had a greater impact on PRWE scores and increased the amount of extension loss. The union rate was 91.6%. Graft resorption was observed in 3 patients and was associated with decreased extension and flexion. The average pinch and grip strengths of the injured hands were 23.2 (SD 6) and 100.4 (SD 15.3) pounds, respectively, which were comparable with those of uninjured hands. One patient incurred implant failure, and another had spontaneous fusion of the PIP joint. The long-term results of hamate osteochondral grafts for PIP fracture-dislocation have generally acceptable clinical and radiologic outcomes. Despite reduced ROM and autograft changes, grip and pinch strengths and subjective outcomes are satisfactory. Therapeutic IV.