A Two-Pin Method for Improved Exposure in Shotgun Hemi-Hamate Arthroplasty

This technical note introduces a two-pin technique designed to improve exposure during the shotgun approach for hemi-hamate arthroplasty, a surgical procedure commonly used to treat comminuted intra-articular and chronic proximal interphalangeal (PIP) joint fractures. A 1.0 mm Kirschner wire (K-wire) is inserted into the middle phalanx (P2) distal to the fracture, and a second K-wire is placed into the head of the proximal phalanx (P1). These pins stabilize the joint, facilitate soft tissue retraction, and improve visualization of the fracture site. The graft is harvested from the dorsal distal hamate and shaped to fit the PIP joint before fixation. This method addresses key challenges in visualization and stabilization associated with the shotgun approach. Early feedback suggests improved surgical efficiency, increased accuracy of reduction, and potentially better functional outcomes. The described two-pin technique is simple and reproducible, significantly enhancing exposure and stability during hemi-hamate arthroplasty. Further studies are needed to confirm its long-term effects