Abstract
Dorsal dislocations of proximal interphalangeal joint with palmar lip fractures base of middle phalanx of fingers are rare, complex, and often a challenging injury to the treating hand surgeons especially in those chronic cases. Hemi-hamate arthroplasty is the preferred surgical option in treating chronic dorsal fracture-dislocations of the proximal interphalangeal joint. We report two cases with a chronic injury that have been treated with hemi-hamate arthroplasty. Range of motion, pinch and grip strengths, QuickDASH scores, complications, and radiological findings were recorded at follow-up. Good functional outcomes were observed in both patients without major complications. Hemi-hamate arthroplasty can be a reliable surgical treatment for chronic proximal interphalangeal joint fracture-dislocations.
Highlights
Dorsal fracture-dislocations of finger proximal interphalangeal (PIP) joint are uncommon, difficult to treat and debilitating injuries
We report two cases with chronic fracture-dislocation of PIP joint that treated successfully with hemi-hamate arthroplasty (HHA)
The treatment choice is based on the congruity and stability of the joint post closed reduction, and the options include dorsal block splint, distractive dynamic fixator, open reduction and internal fixation, volar plate (VP) arthroplasty, and HHA
Summary
Dorsal fracture-dislocations of finger proximal interphalangeal (PIP) joint are uncommon, difficult to treat and debilitating injuries. A 28-year-old man presented six months after an injury in the futsal game, which was missed initially He had persistent pain, swelling, and stiffness over the left middle finger (MF) PIP joint. The radiographs showed a fracture base of the proximal phalanx with dorsal subluxation of the PIP joint (Figure 1A). He underwent HHA at 28 weeks after injury. There was swan neck deformity with ROM of PIP joint -10-70o and distal interphalangeal joint 20-50o (Figure 2C, 2D) He regained good grip and pinch strength, which were 32 kg/force (88.9 % of normal side) and 6.0 kg/force (92.3% of normal side), respectively. The flexor sheath and VP were repaired to prevent joint hyperextension
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