Hemi-Hamate Arthroplasty in Chronic Proximal Interphalangeal Fracture-Dislocations: A Comprehensive Retrospective Analysis

Abstract Background: Chronic proximal interphalangeal (PIP) joint injuries often present with secondary complications such as joint incongruity, soft tissue fibrosis, and degenerative changes, leading to impaired hand function. Hemi-hamate arthroplasty (HHA) has been described as a viable reconstructive technique for restoring joint congruity and stability in such complex cases. Purpose: To evaluate the clinical outcomes, complications, and functional recovery following hemi-hamate arthroplasty in patients with chronic dorsal fracture-dislocations of the PIP joint. Methods: A prospective study was conducted on 12 patients (mean age: 33.9 years; range: 25-41 years) presenting with chronic dorsal fracture-dislocations of the PIP joint, treated with HHA. All patients had injuries older than 30 days, with articular involvement exceeding 40%. The surgical technique included volar plate release, debridement of the joint surface, and reconstruction using an osteochondral graft harvested from the hamate. Patients underwent standardized postoperative rehabilitation. Outcomes assessed included range of motion (ROM), grip strength (compared to the contralateral hand), pain (VAS score), and complications over a mean follow-up of 15 months. Results: All grafts demonstrated radiographic union within 6–8 weeks. The average PIP joint ROM was 94.5°, and grip strength recovered to 90% of the contralateral hand. Pain scores improved significantly postoperatively. Two patients developed mild radiographic osteoarthritic changes, but no donor site morbidity or graft resorption was observed. Conclusion: Hemi-hamate arthroplasty offers a reliable reconstructive option for chronic PIP joint injuries, providing pain relief, restoration of joint stability, and satisfactory functional outcomes. It remains a valuable technique in salvaging joints otherwise destined for arthrodesis or implant arthroplasty. Level of Evidence: Level IV (case series).