Managing Intra-Articular Fractures of the Proximal Interphalangeal Joint Using the Hemi-Hamate Arthroplasty

Case Overview: The proximal interphalangeal joint (PIPJ) is the most commonly injured joint of the hand. Fracture-dislocations of the PIPJ remain a challenge to the hand surgeon. Splinting and internal fixation often result in unsatisfactory outcome with impaired hand function, pain and premature osteoarthritis. Interphalangeal fractures can be unstable, and difficult to treat surgically, in order to restore joint alignment to enable early mobilisation. Surgical approaches vary hugely between hand surgeons as there is currently no gold standard for the management of this heterogeneous group of patients. The hemi-hamate arthroplasty (HHA) is an elegant autologous spare-part procedure that incorporates composite tissue from the hamate to reconstruct the fractured base of middle phalynx. It was first described by Hastings et al in 1999 for the management of PIPJ fracture-dislocations to reconstruct the palmar buttress of the middle phalanx. Despite this, the technique is not widely practiced amongst hand surgeons, owing to its relative novelty and perceived technical difficulty. There is growing evidence to demonstrate excellent functional outcome of the PIPJ following HHA. (5,7,8) We would like to submit the video of a 45-year old carpenter with a fracture-dislocation of his dominant hand ring finger PIPJ, undergoing a HHA reconstruction of the middle phalynx base. Our video will be of educational value to hand surgeons with an interest in managing PIPJ fracture-dislocations, and will enable them to add the HHA to their armamentarium when managing these complex injuries.