Proximal Interphalangeal Joint Injuries Research Articles

Dynamic Suzuki frame for the interphalangeal joint fracture: A case report

Proximal interphalangeal (PIP) joint injuries are one of the common injuries of hand. Most common in motor vehicle accidents and sports injury. Various treatment modalities are available to treat such fractures like buddy strapping with or without extension block splint, CRPP, ORIF with interfragmentary screws, Schenck dynamic traction, Hynes and Giddings device and many other modalities. This is one of the challenging fractures as there is high incidence of stiffness, loss of function and deformity leading to disability following the treatment. The pins and rubber traction frame (Suzuki frame) system is one of the novel technique to reduce the disability.Case: 66 years old male with history of motor vehicle accident, presented with comminuted intra-articular fracture of base of middle phalanx (PIP joint) extending distally to DIP joint of the fourth finger of left hand. We used Suzuki frame for the treatment of the fracture.Suzuki frame technique is a simple, minimally invasive, soft tissue sparing, cost effective, dynamic external fixation technique, can be done at minimal resource setting, which allows early ROM at PIP and DIP joint, enabling good bone and joint remodeling and good function of the finger, leading to disability free hand with minimal complication rate.

Unstable Middle Phalanx Base Fractures Treated With an Internal Joint Stabilizer: Preliminary Results.

Unstable fractures of the base of the middle phalanx are notorious for causing chronic loss of proximal interphalangeal (PIP) joint function, and they remain a challenge for the hand surgeon. We report on a temporary intraoperatively constructed internal joint stabilizer for unstable PIP joint injuries. Across 2 institutions, a retrospective chart review was performed for cases with acute presentation of pilon fracture or fracture-dislocation of the base of the middle phalanx which were surgically treated with an internal joint stabilizer. Information collected included time from injury to surgical intervention, time from implantation to device removal, complications, and preoperative and postoperative range of motion. Seven patients met the inclusion criteria with a mean age of 51 (range: 24-72) years and a mean follow-up of 29 (range: 11-72) months. After removal of the fixator, the mean arc of PIP joint motion was 8° to 88° (range: 0°-100°). There were no infections, no hardware loosening or failures, and no revision procedures. The current findings are comparable to the results for dynamic external fixators. An internal joint stabilizer for unstable injuries to the base of the middle phalanx provides satisfactory functional outcomes, allows early postoperative motion, and mitigates the routine complications which may arise with external fixation.

The Accuracy and Cost-Effectiveness of MRI Assessment of Collateral Ligament Injuries of the Lesser Digits' Proximal Interphalangeal Joints.

BackgroundCollateral ligament injuries of the thumb and lesser digits are simple injuries, but they may lead to disabilities in hand function. This study aimed to evaluate the accuracy and cost-effectiveness of magnetic resonance imaging (MRI) in diagnosing proximal interphalangeal (PIP) collateral ligament injuries of lesser digits.MethodsA retrospective evaluation was conducted on 18 fingers that had undergone surgery for PIP joint complete collateral ligament injury. Pre-operative MRI results were compared with the intra-operative findings. The data from MRI and direct intraoperative findings were analyzed by the Chi-square test in paired groups. The McNemar test analyzed the accuracy of the MRI test for detecting volar plate injuries. Statistical Packages for Social Sciences (SPSS) version 25 (IBM Inc., Armonk, New York) software program was used for the analysis. ResultsIn digits other than the thumb, the accuracy of MRI for detecting collateral injuries was 38.89%, and detection was incorrect in 11 (61.11%) of 18 patients. There are significant differences between MRI and Intraoperative results (p<0.001). MRI findings for seven fingers (38.89%) of the 18 fingers involved were compatible with the surgery results (38.88%). By comparison, the MRI findings of 11 fingers (61.11%) were inconsistent with the intra-operative results. Eight patients (44.44%) were diagnosed preoperatively with MRI as having volar plate ruptures, three patients (16.67%) were diagnosed with open surgery, but only three of the volar plate diagnosed patients with MRI were verified as ruptures during open surgery (38.0%). In addition, preoperatively undetected volar plate injuries by MRI (n=10) were detected intra-operatively in three cases (30.0%). Therefore, the accuracy of MRI was found not to be statistically significant for the detection of volar plate injuries (p=0.727).ConclusionThis study concluded that a 1.5-Tesla MRI with a slice thickness of 2-3 mm should not be relied on as a decisive tool for diagnosing collateral ligament injuries of the PIP joint of the lesser digits. Additionally, MRI was found insufficient for diagnosing volar plate injuries that accompanied collateral ligament injuries. Given these findings, one might conclude that MRI is not cost-effective in diagnosing collateral ligament injuries of the lesser digits PIP joint.

Proximal Interphalangeal Joint Congruity: A Biomechanical Study.

Surgical approaches to the proximal interphalangeal (PIP) joint often require disruption of soft tissue stabilizers. Additionally, PIP joint injuries frequently result in soft tissue disruption. This study evaluates the necessity of repairing soft tissue stabilizers by assessing their role in maintaining native joint congruity. Eight specimens were used to evaluate congruity at 0° and 30° flexion when loaded with 2 N of valgus force. This was performed in the native joint and after sequential sectioning of the surrounding ligaments in order: volar plate (VP), radial collateral ligament (CL), and ulnar CL. The skin flap was sutured with the ligaments unrepaired and the load was reapplied. Radiographs were taken after each load and used to measure the joint line convergence angle (JLCA). Mean JLCA increased in both degrees of flexion after ligaments were sectioned but was only significantly different from the native joint after the VP was disrupted along with 1 CL. Joint congruity improved following repair of the skin flap in both degrees of flexion but was not significant. Joints were more congruent in 30° flexion for all subgroups, but none were significantly different compared to 0° flexion. Disruption of the VP is insufficient to significantly alter PIP joint congruity. While sectioning of both the VP and CLs resulted in a statistically significant change in joint congruity, mean JLCA demonstrated changes of minor clinical significance. The osseous anatomy of the phalanges imparts inherent stability that maintains a congruent joint despite loss of the soft tissue stabilizers.

Proximal interphalangeal joint arthrodesis in horses: concepts, indications, and techniques

Surgical arthrodesis is effective for treating proximal interphalangeal joint (PIJ) injuries in horses. Despite several techniques described so far, the use of a 3-hole, 4.5mm-locking compression plate, associated with two 5.5-mm transarticular cortex screws, is currently considered the “gold standard.” This review describes the anatomy of the pastern, as well as causes, indications, and possibilities for arthrodesis in the equine PIJ. A description of the current surgical technique for joint fixation is also presented.

Percutaneous Intramedullary Reduction Technique for Impacted Middle Phalanx Base Fractures.

Proximal interphalangeal joint injuries are common and are a major risk for functional deficits of the finger that affect range of motion and grip strength. Impacted intra-articular fractures and fracture dislocations of the middle phalanx base are challenging to treat because of troublesome joint reduction and difficulties in achieving articular congruity. Although treatment algorithms have been published, the anatomically delicate proximal interphalangeal joint often remains incomplete in function and may result in post-traumatic pain, stiffness, and osteoarthritis. This article describes a percutaneous intramedullary reduction technique for impacted middle phalanx fractures as a treatment option to achieve articular congruity with minimal surgical trauma. The reduction technique may be considered for selected patients with impacted fractures of the base of the middle phalanx with or without joint dislocation.

Dynamic external fixators for the proximal interphalangeal joint injuries: detailed biomechanical analysis of effectiveness

Backgrounds: Proximal interphalangeal (PIP) joint injuries can cause scar contractures by different mechanisms, leading to significant functional loss, the most important thing in the treatment process is to maintain joint mobility, in this way, scar formation will be reduced. Dynamic external fixators have been used for this purpose. Although it is an old method, it has many unknown aspects. Materials and Methods: Nineteen patients participated in our study. The patients were divided into two groups as those who were treated immediately after the injury and those who applied in the late period. All patients were treated with pin and rubber traction systems (PRTS). After 6 weeks of traction, the fixator was removed. Patients were assessed with X-rays for the amount of distraction, Visual Analog Scale score for pain and quick DASH scores for satisfaction. The patients were also examined for passive and active range of motion (AROM) in all controls. Results: We compared the preoperative and postoperative data of the patients and also we compared the amount of distraction with functional gain. There was no relationship between the increase in PIP joint space distance and posttreatment PIP joint AROM values. Hence, the amount of distraction on the joint space distance has no direct effect on the functional results. Another important result of the study is that the loss of extension in the PIP joint, which can be unregarded in the early period, negatively affects the late results. The other important result of our study is that successful results can be obtained when applied in combination with surgery in delayed cases. Conclusion: The use of PRTS has an important role in the treatment of PIP joint injuries. In our study, we have shown that satisfactory results can be obtained in both acute and delayed cases when combined with additional surgery or applied alone. The change in joint space distance during the patient follow-up is not an important issue in terms of range of motion. Another important result we obtained from the study is the demonstration that PRTS can be successfully used in untreated joint dislocations in a single stage.

A Novel Technique for Dynamic External Fixation of Proximal Interphalangeal Joint Fracture-Dislocations.

Background: The pins and rubbers traction system is widely used to treat unstable proximal interphalangeal (PIP) joint fracture-dislocations. However, dealing with rubber bands can be difficult due to its elasticity and weakness. The purpose of this study was to report the results of an alternative dynamic external fixator technique for unstable PIP joint injuries. Methods: Thirteen patients with acute unstable PIP joint fracture-dislocation (n = 8), pilon fracture (n = 2), or comminuted shaft fractures of a middle phalanx with or without PIP joint extension (n = 3) were enrolled. The alternative fixator used a plastic syringe to maintain distraction force instead of the commonly used rubber bands. Four patients underwent combined open reduction due to unsatisfactory reduction by closed mean. The fixator was removed when there was radiographic evidence of healing. Results: At 6 months after the operation, the mean active ROM of the injured PIP joint was 89° (range, 70-104°), and the mean Quick-DASH score was 9.78 (range, 0-40.9). The mean NRS of pain before fixator removal was 1 (range, 0-4). One patient had a pin tract infection and underwent debridement and fixator removal at 33 days postoperatively. There was no loss of reduction or implant failure in the study. Conclusions: The results were comparable to other dynamic external fixation techniques used for unstable PIP joint fracture-dislocations. The main advantages of this technique were strength of the system, procedure simplicity, the compact design, and relatively low cost. In addition, this technique can also be used in pilon fractures and comminuted shaft fractures of a middle phalanx with or without PIP joint extension.

Application of foot commonpedicle bilobed flap combined with iliac crest bone graft for repair of penetrating finger injuries

Objective To investigate the clinical efficacy of foot commonpedicle bilobed flap combined with iliac crest bone graft for reconstruction of penetrating finger injuries. Methods From November 2013 to December 2017, 7 cases of penetrating finger injuries were treated by foot commonpedicle bilobed flap or tibial second toe flap with iliac crest bone graft. The donor site of the toe was covered by lower abdominal free skin graft. Results All the flaps survived uneventfully. Partial necrosis of the toe donor site occurred in 1 case which healed after dressing change. The rest donor sites achieved primary healing. The healing time of bone was 2. 0 to 2. 5 months. Postoperative follow-up ranged from 3 to 12 months with an average of 6 months. No bone resorption was found in the transplantation of iliac bone. The flap had good texture and no obvious bulky appearance. The sensation of fingers and flaps recovered to S2to S4. Local scar hyperplasia in the donor site occurred in 1 case. There was no significant scar contracture and influence on foot function. The proximal interphalangeal joint activity of 6 cases without involvement of the proximal interphalangeal joint injuries ranged from 60° to 80° averaging 70°. Joint fusion in functional position was performed in 1 case of damaged proximal interphalangeal joint. Conclusion Foot commonpedicle bilobed flap combined with iliac crest bone graft is an ideal method for reconstruction of penetrating finger injuries. Key words: Finger injuries; Surgical flaps; Commonpedicle; Microsurgery

Efficacy of orthotic devices for increased active proximal interphalangeal extension joint range of motion: A systematic review

Study DesignSystematic review. Introduction/Purpose of the StudyTo determine the efficacy of orthotic devices for increased active proximal interphalangeal (PIP) joint range of motion and optimal wearing schedule of the devices to guide clinical practice. The secondary purpose is to capture the outcome measures used by the authors. The final purpose was to determine if recent studies addressed patient satisfaction and adherence in the orthotic management of a PIP joint injury. MethodsA comprehensive literature search was conducted using the search terms splint, orthotic device, hand orthotic, brace, proximal interphalangeal joint, occupational therapy, and physical therapy using PubMed, CINAHL, MEDLINE, and ProQuest. The following data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines: background statement, objectives, data sources, study eligibility criteria, participants, and interventions, study appraisal and synthesis methods, results, limitations, conclusions, and implications of key findings. ResultsBest results were achieved when the PIP orthoses were worn for a longer duration especially for the treatment of extension deficits. DiscussionStudies that provided a wearing schedule of a minimum of 6 hours obtained the greatest improvements in extension deficits of the PIP joint. ConclusionRecommended orthotic dosage to treat PIP joint injury is at least 6 hours a day for 8-17 weeks.

Orthotic management of fixed flexion deformity of the proximal interphalangeal joint following traumatic injury: A systematic review.

Background/objectiveFixed flexion deformity of the proximal interphalangeal joint can commonly occur following a traumatic injury impacting on hand function and occupational performance. Numerous interventions have been proposed for fixed flexion deformity resolution. This paper investigates the efficacy of static or dynamic orthoses in reducing fixed flexion deformity contracture following traumatic proximal interphalangeal joint injury.MethodsA multi-database search of three databases (CINAHL, EMBASE, MEDLINE) was conducted. Data extracted for each study were design, patient descriptions, degree of fixed flexion deformity pre- and post-orthoses, and prescribed interventions and exercise programmes.ResultsThe search yielded 643 studies, of which eight met the inclusion criteria. Studies used heterogeneous methodologies investigating various orthotic interventions. Meta-analysis or pooling of results was not possible. Dissimilar orthotic wear regimes were noted in all studies and an alternative clinical significance outcome was found.ConclusionMore research is required to support clinical reasoning in orthotic choice for fixed flexion deformity of the proximal interphalangeal joint post-traumatic injury.

Ténodèse du flexor digitorum superficialis pour les déformations en hyperextension de l’articulation IPP dans l’arrachement chronique de la plaque palmaire

Purpose Injuries of finger proximal interphalangeal (PIP) joint are among the most common trauma of the upper limb. As a result of a severe PIP sprain, the avulsion of the volar plate from the phalanx can lead to instability of the joint. This lesion causes a finger hyperextension disabling deformity, which leads to pain and functional restriction. A late diagnosis is not infrequent and the volar plate is usually retracted or thinned, thus a functional repair has to be researched. With this goal Littler, conceived a flexor digitorum superficialis tenodesis (FDS) in 1959. The purpose of this report is to describe a modified Littler FDS tenodesis technique for the correction of chronic, traumatic joint hyperextension of PIP joint and to present the follow-up. Nine patients presenting a chronic, post-traumatic PIP joint hyperextension were evaluated by one of the consultant in hand surgery. They were treated with a modified Littler FDS tenodesis using a mini bone-anchor placed on the volar aspect of the P1, to insert and stretch directly the tendon slip. Patients were reviewed and evaluated at a follow up of 12 months. Results were classified as excellent in 2 cases, good in 6 cases, fair in one case. To make the tenodesis, the flexor sheath was incised between the A1 and A2 pulleys. The ulnar slip of the FDS was cut as proximally as possible. A mini bone anchor was then placed at the centre of the P1 in a slight sidelong proximal-to-distal direction. The FDS slip was sutured to the anchor, carefully tensioning it so that the PIP joint was approximately 5°-10° short of full physiological extension. The wound was covered with a slight dressing and a temporary small orthoses was applied dorsally, leaving the flexion motion free. Patients were invited to start an immediate gradual active motion. We believe that the results of this PIP tenodesis are strongly related with the fixation technique of the tendon slip. The goal is to avoid a wide opening of the flexor sheath, a long postoperative immobilization, rehabilitation and splinting. The results of FDS tenodesis using a mini-invasive technique and starting an immediate postoperative assisted mobilization, seem to be good and reliable over time.

Reduction of a finger in the out-of-hospital arena?

Introduction: Paramedics can find themselves called to digit dislocations. This is challenging as a dislocation can present in various ways, bringing residual damage to tissue and underlying structures from prolonged displacement. The aim is to limit impact on the welfare of the patient and the paramedic's objective is always to get the dislocation reduced as soon as a possible in a quick and safe manner. Dislocation: The most common dislocation of the digit is at the proximal interphalangeal joint (PIPJ), also known as the ‘coach's finger’. PIPJ injuries are commonly seen in ball sports; the dislocation is mainly dorsal in presentation, and normally closed and stable. It is vital that the paramedic undertakes an in-depth digit assessment in order to be equipped with an appropriate treatment plan for the presentation, which can manage the dislocated digit. Discussion—pain relief: While there has been extensive study of systemic analgesia in emergency medical services (EMS), there is little out-of-hospital research on digit ring blocks and the use of regional anesthetics by paramedics in the pre-hospital setting. X-ray: The evidence is contradictory as some insist that X-ray must be carried out pre-reduction, where other authors state that reduction first is acceptable, but only after a thorough assessment. Reduction: There is a distinct lack of evidence for out-of-hospital digit reduction, too sparse for any robust argument to be built. Conclusion: The suggestion is that reduction of the PIPJ dislocation in the out-of-hospital arena is not supported, owing to a lack of evidence. Until more studies are carried out and patient follow-up is proved to be negative with no ongoing digit impact, this skill needs to be undertaken in appropriate locations supported by X-ray.

Factors influencing functional outcome of proximal interphalangeal joint collateral ligament injury when treated with buddy strapping and exercise

Study DesignProspective cohort. Introduction and PurposeThis study evaluates the factors influencing treatment outcomes of proximal interphalangeal (PIP) joint collateral ligament injuries when treated with buddy strapping. MethodsSixty-seven patients treated with buddy strapping for a PIP joint injury were enrolled. The finger range of motion (ROM), grip strength, and a Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) score were assessed at 3 and 6 months after the initial injury. The factors that were assessed for their influence on the functional outcomes included age, sex, hand dominance, affected finger, type of injury, injury severity, time to treatment, the duration of buddy strapping, and exercise training. ResultsBuddy strapping for PIP joint injuries led to satisfactory results with 77% recovery of grip strength, 84% recovery in ROM, and mean QuickDASH scores of 14 at 6 months. A decrease in grip strength was associated with an increase in age and injury severity at 6 months, and these 2 factors accounted for 22% of the variance in the grip strength. A decrease in ROM was associated with the delayed treatment, which accounted for 18% of the variance in ROM at 6 months. An increased disability was associated with delayed treatment, female gender, and radial digit injury at 3 months, and these 3 factors accounted for 37% of the variance in disability. At 6 months, only the delayed treatment remained an associated factor, which accounted for 20% variance in disability. Discussion and ConclusionsPIP collateral ligament injuries had very good outcomes with buddy strapping. However, delayed treatment was significantly associated with poor functional outcomes in terms of the ROM and disability. An increase in age and injury severity were associated with lower grip strength up to 6 months, whereas a female gender and radial digit injury were associated with an increased disability up to 3 months. Level of evidence2

Predicting serious complications and high cost of treatment of tooth-knuckle injuries: a systematic literature review.

The tooth-knuckle injury (TKI) is a serious and potentially costly injury seen in orthopaedic practice. The aim was to conduct a systematic literature review on the factors associated with serious complications and high treatment costs in tooth-knuckle injuries. MEDLINE, Scopus and CINAHL were used as the literature sources. Original research papers that reported on factors predicting serious complications and high treatment costs in TKIs were included. There were no restrictions placed on study size, language, study design or date of publication. Case studies, case series and review articles were not included. After duplicates were removed, 403 unique studies remained; after titles and abstracts were screened, 48 titles remained and were retrieved in full text. Of these, 14 titles met the inclusion criteria and were included in the data synthesis. Tenosynovitis, septic arthritis, osteomyelitis and residual stiffness were common serious complications occurring in up to 36.3, 70.0, 47.6 and 65.3% of cases, respectively. Amputation was also common in up to 18.0% of injuries. Treatment costs were measured by length of hospital stay and the number of debridements required. On average, patients required 3.8-8days of admission and 1.3-2.7 debridements each. Increased time delay from injury to treatment, deeply penetrating injuries, proximal interphalangeal joint (PIPJ) injuries and, possibly, E. corrodens infections were associated with serious complications in TKIs. Delayed treatment, inadequate treatment, PIPJ injuries and deeply penetrating injuries predicted higher treatment costs. PROSPERO CRD42016029949 ( http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42016029949 ).

Ultrasonographic characteristics of volar-lateral ligament constrains after proximal interphalangeal joint injuries

Objective To characterise posttraumatic constrains of the volar-lateral ligaments by analysing volar plate (VP) dynamics after proximal interphalangeal (PIP) joint injuries using ultrasonography.Materials and methods From the anatomical and biomechanical perspectives of the VP and its surrounding structures, posttraumatic constrains of the volar-lateral ligament were evaluated by analysing the changes of VP motion. Using ultrasound, VP motion during active flexion of 0–60° was recorded in the central sagittal plane at 12 weeks after injury. VP trajectories visualised by 5-point tracing on the VP were analysed qualitatively to detect differential patterns of the ligament constrains. Quantitatively, correlation between averaged constrain index determined by measuring volar locational values of the 5 points on the VP and limitation in extension at the final follow-up was assessed.Results Eleven patients with PIP joint injuries involving five VP avulsions, three volar intra-articular fractures, or three dorsal fracture-dislocations were included. All patients with VP avulsion revealed a totally-constrained pattern, whereas patients with intra-articular or fracture-dislocation injuries showed distally-constrained pattern or normal. Averaged constrain index was negatively correlated with limitation in extension, indicating positive contribution of volar-lateral ligament constrains to residual flexion contracture.Conclusion Ultrasonographic visualisation of VP motion characterised posttraumatic constrained conditions of the volar-lateral ligaments. Knowledge of the manner of ligament damages might be useful to set treatment strategies for PIP joint injuries.

Treatment of fracture subluxations of the proximal interphalangeal joint using a ligamentotaxis device: a multidisciplinary approach.

Complex fracture subluxations of the proximal interphalangeal joint are often difficult to treat and their outcome variable. A number of methods for treatment of these injuries have been described. We have used a ligamentotaxis device (Ligamentotaxor, Arex, Palaiseau Cedex, France) since 2008. We performed 28 operations in 28 patients with complex proximal interphalangeal joint injuries over a 3-year period. Patients followed a standardized postoperative rehabilitation regime, including fixator adjustment as necessary. The mean age was 33 years (range 18-67). The mean time to surgery was 7 days. At final follow-up (mean 22 months, range 6-52) the mean proximal interphalangeal joint range of motion was 85° (range 60°-110°). The mean QuickDASH functional outcome score was 4.8 (range 0-36.4). Our results compare favourably with other devices reported in the literature.

The management of clenched fist 'fight bite' injuries of the hand.

We present a prospective study outlining the management of clenched fist 'fight bite' injuries. Over a 4-year period all patients with such injuries had surgical exploration with further débridements as necessary. For metacarpophalangeal joint injuries, a midline tendon-splitting approach was used. For proximal interphalangeal joint injuries, an approach was made between the lateral band and central slip of the extensor mechanism. A total of 147 patients with 159 joint injuries were treated, with 130 metacarpophalangeal joint and 29 proximal interphalangeal joint injuries. The joint was penetrated in 96% of joints overall. The number of débridements ranged from two to eight. Twenty patients defaulted within 1 week of surgery and were not included in the analysis of the results. All patients with metacarpophalangeal joint injury had satisfactory or good outcomes. A total of 42% of patients with proximal interphalangeal joint injuries had poor results, four requiring amputation and one a fusion. The tendon-splitting approach to the metacarpophalangeal joint allows excellent access and avoids damage to the sagittal bands and consequent instability of the extensor mechanism.

Volar Base Fracture of the Second Phalanx: A Small Fracture a Great Challenge

Proximal interphalangeal joint (PIP) injuries can be disabling and are among the most challenging areas of hand surgery. The PIP joint is a complex, delicate and very stable hinge articulation that provides almost 100 degrees of flexion and thus serves as the cornerstone of the human hand movements. Injuries of the volar base of second phalanx (P2) deserve a special attention due to the complexity of their nature and management process. Volar plate and special cup shape geometry of the articular surface of the base of the P2 along with its volar lip prevent dorsal translation of this phalanx. For decades, volar plate arthroplasty was the preferred technique in reconstruction of comminuted and approximately irreparable volar base fracture of the P2 but there was a great concern about the re-subluxation and higher failure rate of the traditional volar plate arthroplasty. Hemi-hamate arthroplasty a novel technique introduced to the hand surgery world by Hastings in 1999 (1). In this technique the dorsal distal portion of hamate articular surface adjacent to the base of two ulnar carpometacarpal articulations bones is harvested. The bed of the volar base of the P2 is prepared by using mini oscillating saw and resection of the comminuted segments of its volar base. The harvested autograft transferred after 180 degrees rotation in two planes into the prepared bed at the volar base of the P2, and stabilized with two or three mini-fragment lag screws, the stability of pip can be restored by rebuilding the cupshaped geometry of the P2 base and palmar plate attachment. The volar overhanging lip of P2 can be reconstructed in this technique. Hemi-hamate has the capability of serving as salvage procedure after failed external fixation, open reduction and internal fixation or volar plate arthroplasty. Recently published longer term follow up of hemi-hamate arthroplasty indicates a valuable surgical procedure to address severe PIP joint fracture–dislocations (2). As the main referral orthopedic center in the country we had the same experience with this reconstruction at the department of hand surgery of Shafa Orthopedic Hospital. We do believe that managing of pip fracture dislocation has ushered in a new era with Hemi-hamate arthroplasty.

Current Trends in the Management of Proximal Interphalangeal Joint Injuries of the Hand

Injuries to the proximal interphalangeal joint are commonly encountered by the hand surgeon. Proper diagnosis and treatment are vital for optimal outcomes. Proper treatment of these injuries requires a working knowledge of the anatomy of the joint and an appreciation for principles for reduction, stabilization, and early rehabilitation to provide the best outcomes possible. Injuries can include fractures of the head of the proximal phalanx, dislocations, fracture dislocations, and fractures of the base of the middle phalanx. Similar to other aspects of plastic surgery, there is little high-level evidence guiding treatment and thus most treatment is based on level III or IV evidence. The goal for treatment of any injury around the proximal interphalangeal joint is to establish a congruent joint and allow for early motion. Stiffness and posttraumatic arthritis are common following these injuries. Salvage procedures are limited to arthrodesis and arthroplasty, neither of which can restore the normal function of the hand.