Modified hemi-hamate replacement arthroplasty

BackgroundThe Hemi-Hamate Replacement Arthroplasty (HHRA) described by Hastings is an excellent option in the management of fracture dislocations of the proximal interphalangeal joints (PIPJ) in the hand. We have noted late development of hyperextension deformity in some patients following HHRA.MethodsWe propose a modification to prevent this deformity following HHRA by reattaching the volar plate by a transosseous suture to the reconstructed volar buttress after the hamate graft is secured to the defect. This modification prevents a late hyperextension deformity.ResultsWe reviewed six patients who underwent the modified HHRA. The grafts had united in all patients with an average of 85° of motion at the PIPJ, significant reduction of pain and improvement in grip strength at a minimum follow up of one year. There were no hyperextension deformities.ConclusionsThe modified HHRA for neglected PIP fracture dislocation appears to augment the PIP joint stability following the HHRA procedure and prevents late deformity in chronic cases.