A Hemi-Hemi-Hamate Osteochondral Graft: A Modified Hemi-Hamate Technique for a Unicondylar Defect

TL;DR

A new surgical technique is introduced to treat complex finger joint fractures by using a modified osteochondral graft.

Contribution

The novel hemi-hemi-hamate osteochondral graft is introduced for reconstructing specific joint defects.

Findings

The modified graft is suitable for whole anteroposterior hemiarticular surface bone loss at the base of the P2.

The technique addresses challenges in restoring joint stability and function after comminuted fracture dislocations.

Abstract

Articular comminuted fracture dislocations of the base of the middle phalanx represent a major challenge for the surgeon. The treatment goal is a nonpainful, stable, and functional proximal interphalangeal joint, which is achieved through concentric joint reduction and restoration of joint stability. Fracture pattern rarely results in sagittal bone loss involving the entire ulnar or radial pilon of the base of the second phalanx. In these cases, the choice of treatment can be particularly challenging as the loss of a pillar of the articular base causes angular deviation at the joint level, thus causing the loss of finger joint flexion and overlap of the adjacent finger. We present a novel nonvascularized osteochondral graft, which we named hemi-hemi-hamate osteochondral graft, a modified version of the traditional hemi-hamate arthroplasty, that is suitable for the reconstruction of bone loss involving the whole anteroposterior hemiarticular surface of the base of the P2.

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