Biomechanical characteristics of hemi-hamate reconstruction versus volar plate arthroplasty in the treatment of dorsal fracture dislocations of the proximal interphalangeal joint

Andrew R. Tyser, Michael A. Tsai, Brent G. Parks, Kenneth R. Means

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose To compare stability and range of motion after hemi-hamate reconstruction versus volar plate arthroplasty in a biomechanical proximal interphalangeal (PIP) joint fracture-dislocation model. Methods Eighteen digits from 6 cadaver hands were tested. We created defects of 40%, 60%, and 80% in the palmar base of each digit's middle phalanx, simulating an acute PIP joint fracture-dislocation. Each defect scenario was reconstructed with a hemi-hamate arthroplasty followed by a volar plate arthroplasty. A computer-controlled mechanism was used to bring each digit's PIP joint from full extension to full flexion via the digital tendons in each testing state, and in the intact state. During each testing scenario we collected PIP joint cinedata in a true lateral projection using mini-fluoroscopy. A digital radiography program was used to measure the amount of middle phalanx dorsal translation (subluxation) in full PIP joint extension. We recorded the angle at which subluxation, if present, occurred during each testing scenario. Results Average dorsal displacement of the middle phalanx in relation to the proximal phalanx was 0.01 mm for the hemi-hamate reconstructed joints and -0.03 mm for the volar plate arthroplasty, compared with the intact state. Flexion contractures were noted in each of the specimens reconstructed with volar plate arthroplasty. Degree of contracture was directly correlated with defect size, averaging 20° for 40% defects, 35° for 60% defects, and 60° for 80% defects. We observed no flexion contractures in the hemi-hamate reconstructions. Conclusions Surgeons can use both hemi-hamate and volar plate arthroplasty to restore PIP joint stability following a fracture dislocation with a large middle phalanx palmar base defect. Use of volar plate arthroplasty led to an increasing flexion contracture as the middle phalanx palmar base defect increased. Clinical relevance Clinicians can use the information from this study to help with surgical decision-making and patient education.

Original languageEnglish (US)
Pages (from-to)329-332
Number of pages4
JournalJournal of Hand Surgery
Volume40
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

Keywords

  • Proximal interphalangeal
  • arthroplasty
  • arthroplasty
  • dislocation hemi-hamate
  • joint fracture
  • volar plate

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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