Abstract

Aim: In this study, we aimed to evaluate the results of reconstruction with hemi-hamat osteoarticular autograft in patients with unstable PIP fracture dislocation.
Methods: Reconstruction process applied on the 11 patients autografted with the hemi-hamate osteoarticular bone graft those have unstable pip fracture dislocation and cannot be repaired with the primary surgical techniques. Base of the fractured phalanx prepared. The graft was taken from the dorsal and osteoarticular surface of the hamate, inserted and fixed with the mini screws. Preoperative radiological imaging studies revealed that the middle phalanx volar lip involvement corresponded 50% (interval;40%-60%). Mean surgical delay was 4.9 weeks (interval;3-8 w). PIP range of motion, contracture, stability and VAS were evaluated at a mean follow-up of 30 months. Graft position, collapse and degeneration was evaluated with the radiological techniques.
Results: Average range of motion angle was 86° (interval;80°-100°). Flexion contracture was 10° (interval;0°-20°). In the follow ups with 30 months period postoperatively, total union of the graft was achieved on the radiological confirmation studies. Three out of eleven patients volar sided collapse was seen. But even although in those patients no unstability was occured. Mean VAS of the postoperative follows was 0.27 (interval;0-1). At a mean follow-up of 30 months; the patients were subjectively satisfied and returned to work.
Conclusion: This study showed us articular surface of middle phalanx can be reconstructed with a proper surgical technique. Even if there is a mild extension loss can be seen, functional range of motion was protected. The possible collapse of the graft detected in the follow-ups. To avoid the risk of unstability of the graft volar plate must be repaired. So we minimalize the occurrence risk of complications and excellent functional results are obtained.

Key words: Hemi-hamate, osteoarticuler autograft, PIP joint, fracture-dislocation, volar plate