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Hemi-hamate arthroplasty for the management of chronic proximal interphalangeal joint fracture dislocations: Analysis of 21 cases in Indian population and review of the literature

Published:January 20, 2023DOI:https://doi.org/10.1016/j.jcot.2023.102109

      Abstract

      Background

      Chronic fracture-dislocations involving the proximal interphalangeal (PIP) joint are challenging cases. We conducted this study to analyze the outcomes following hemi-hamate autograft reconstruction of such injuries and to compare our results with the existing literature.

      Methods

      A retrospective analysis of 21 patients with chronic dorsal PIP fracture-dislocations that were managed with hemi-hamate autograft reconstruction was done. The average articular surface involvement was 64%. The average duration between injury and surgery was 9.4 weeks (range, 6–16). Quick DASH (Disabilities of Shoulder and Hand) scores, VAS (Visual Analog Scale) scores, range of motion of the PIP joints, DIP (distal interphalangeal) joints, and MCP (metacarpophalangeal) joints were measured during serial follow-up visits.

      Results

      Union and graft incorporation was seen in all cases. The average Quick DASH score at four weeks post-surgery was 66 and it improved to eight at one year (p-value<0.05). The average VAS score at four weeks post-surgery was 7.66 and it improved to 2.09 at one year (p-value<0.05). The mean flexion of the MCP joint improved from 52.85° at the end of four weeks to 72.38° at one year (p-value<0.05). The average flexion at the PIP joint improved from 10.47° at the end of four weeks to 70.47° at one year (p-value<0.05). The average DIP flexion improved from 38.33° at the end of four weeks to 62.38° at one year (p-value<0.05). The average hand grip strength was 85% of the normal side.

      Conclusion

      Hemihamate autograft reconstruction is a suitable procedure for the management of chronic PIP joint fracture-dislocations, especially in cases with extensive involvement of the articular surface.

      Level of evidence

      III.

      Keywords

      1. Introduction

      Chronic proximal interphalangeal joint fracture-dislocations are defined as injuries that are more than six weeks old.
      • Elfar J.
      • Mann T.
      Fracture-dislocations of the proximal interphalangeal joint.
      ,
      • Dionysian E.
      • Eaton R.G.
      The long-term outcome of volar plate arthroplasty of the proximal interphalangeal joint.
      In most cases, the direction of dislocation associated with PIP injuries is dorsal.
      • Kiefhaber T.R.
      • Stern P.J.
      Fracture dislocations of the proximal interphalangeal joint.
      ,
      • Hastings 2nd, H.
      • Carroll 4th, C.
      Treatment of closed articular fractures of the metacarpophalangeal and proximal interphalangeal joints.
      Injuries that involve less than 30% of the surface of the middle phalanx are considered to be stable. It is recommended that surgical reconstruction of PIP fracture-dislocations should be performed when the fracture has involved 30%–50% of the base of the middle phalanx or when the degree of flexion required for maintaining reduction is more than 30°.
      • Williams R.M.
      • Kiefhaber T.R.
      • Sommerkamp T.G.
      • Stern P.J.
      Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft.
      Involvement of articular surface greater than 50% requires ORIF (Open reduction Internal fixation), while VPA (Volar plate arthroplasty) is preferred in cases with comminution.
      • Kiefhaber T.R.
      • Stern P.J.
      Fracture dislocations of the proximal interphalangeal joint.
      However, there is a higher incidence of undesirable outcomes such as pain, stiffness, and recurrent dislocation when osteosynthesis and VPA are used for the surgical management of unstable PIP joint fracture-dislocations which involve more than 50% of the volar lip of the middle phalanx and hemi-hamate arthroplasty has shown to have favorable outcomes when used in such cases.
      • Deitch M.A.
      • Kiefhaber T.R.
      • Comisar B.R.
      • Stern P.J.
      Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results.
      The present study aimed to analyze the outcomes of this procedure when used for the management of exclusively chronic PIP dislocations (presenting more than six weeks post-trauma) involving more than 50% of the articular surface.

      2. Methods

      After obtaining clearance from the Institutional Review Board and a well-written informed consent from the patients, we performed a retrospective analysis of 21 cases of chronic dorsal fracture-dislocations of the PIP joint involving more than 50% of the articular surface that were managed with hemi-hamate autograft reconstruction by a specialist-highly experienced hand surgeon over four years from 2017 to 2021 with a minimum follow-up of one year. All patients were males with an average age of 31 years (range, 18–58 years) (Table 1). The commonest digit involved was the left ring finger (seven cases) followed by the left middle finger (five cases). The common mechanisms of trauma were falls resulting in hand trauma, blunt trauma to the hand, and injury to the finger while engaging in sports activities. The patients presented to us more than six weeks after the trauma and the average duration between trauma and surgery was nine weeks (range, 6–16 weeks). The average percentage of joint involvement was 64%. The outcomes were assessed using the range of motion measured by a goniometer, hand grip strength, QuickDASH scores, and VAS scores at regular intervals of four weeks, three months, six months, and one year.
      Table 1Demographics of the participants.
      Age (in years)SexDuration between trauma and surgery (in weeks)Finger Involved
      47Male7Left index
      32Male8Right ring
      25Male8Left middle
      30Male12Right index
      44Male9Left ring
      24Male7Left index
      24Male8Left ring
      42Male14Right ring
      32Male11Left ring
      33Male8Left ring
      58Male9Left middle
      18Male10Left middle
      27Male13Left ring
      24Male16Right middle
      21Male12Right middle
      23Male7Left middle
      20Male10Right ring
      21Male8Left index
      37Male7Left ring
      32Male9Left ring
      31Male6Left middle
      Regional anaesthesia and tourniquet were used for all cases. Bruner's skin incisions were used volarly and the digital nerves and arteries were identified. The flexor sheath was incised between the A2 and A4 pulleys and retraction of the flexor tendons was done to provide exposure of the volar plate which was then released from the accessory collateral ligaments. Exposure of the PIP joint was achieved by hyperextending (shotgunning) the PIP joint and a thorough wash was given to remove any remaining loose fragments (Fig. 1). Using a rongeur, a smooth surface was created on the distal volar margins of the middle phalanx base and the dimensions of the defect so created were measured. A longitudinal incision was taken over the fourth and fifth CMC (carpometacarpal) joint and the desired autograft was obtained from the hamate by making the cuts via a saw. The length of the obtained autograft was measured. The autograft was then placed into the bony defect created at the middle phalanx base after contouring it as per the size of the defect and then secured into the defect using two to three bicortical screws or pins under fluoroscopic guidance (Fig. 2). Relocation of the joint was done and it was confirmed that the screws or pins used for fixation were of appropriate length. Reattachment of the volar plate to the stumps of the collateral ligaments was performed and the joint was moved through a complete range of motion under fluoroscopic guidance. A thorough wash was given and the wound was closed in layers after deflation of the tourniquet and an adequate dressing was given following which the wrist and hand were immobilized using a slab in the functional position. Immobilization with the slab was discontinued after two weeks following which immobilization was provided with a splint. This was discontinued at the end of four weeks and range of motion exercises of the hand and wrist were begun under the supervision of a dedicated hand physiotherapist. Following this, a rigorous physiotherapy protocol consisting of resistive active stretching exercises was started and continued till satisfactory hand grip strength was achieved. The Quick DASH scores, VAS scores, PIP, DIP, and MCP range of motion were calculated at an interval of four weeks, three months, six months, and one year (Fig. 3). Grip strength was measured using the Jamar Hydraulic hand dynamometer (Bolingbrook, Illinois). Radiographs were obtained at regular intervals to analyze the union and status of the autograft.
      Fig. 1
      Fig. 1(A) – The incision has been marked preoperatively.
      (B) – The flexor tendons have been retracted to expose the volar plate
      (C) – Hyperextension of the proximal interphalangeal joint (shotgunning) has been done for improving exposure.
      Fig. 2
      Fig. 2(A) – Preoperative clinical image showing restricted flexion of the index finger's proximal interphalangeal joint following trauma.
      (B) – Lateral radiographs show dorsal dislocation following a fracture of the index finger's middle phalanx base.
      (C) – Intraoperative image of the same patient shows that the loose fragments are cleared after giving a thorough wash following hyperextension of the proximal interphalangeal joint.
      (D) – Intraoperative fluoroscopy image shows the hamate graft fixed to the middle phalanx volar base with bicortical pins.
      Fig. 3
      Fig. 3(A) – Preoperative clinical image showing restricted flexion of the index finger's proximal interphalangeal joint.
      (B) – Lateral radiograph shows fracture of the volar middle phalanx base of the index finger.
      (C) – Postoperative radiograph showing restoration of the volar buttress using a hamate autograft fixed with screws.
      (D) – Improved range of motion at a follow-up visit of one year.

      3. Results

      One patient was lost to follow-up due to COVID-19 restrictions. As compared to the uninjured side, the average handgrip strength was 85%. Radiographs assessed at regular intervals showed union in all cases. Resorption of the graft was not noted in any case. The average Quick DASH score at four weeks post-surgery was 66 and it improved to eight at one year (p-value<0.05). The average VAS score at four weeks post-surgery was 7.66 and it improved to 2.09 at one year (p-value<0.05) (Table 2). The average MCP joint flexion improved from 52.85° at the end of four weeks to 72.38° at one year (p-value<0.05). The average flexion at the PIP joint improved from 10.47° at four weeks to 70.47° at one year (p-value<0.05). The average DIP flexion improved from 38.33° at the end of four weeks to 62.38° at one year (p-value<0.05) (Table 3).
      Table 2Detailed post-operative outcome in terms of QuickDASH scores and VAS scores.
      ScoresPost-operative four weeksPost-operative three monthsPost-operative six monthsPost-operative one year
      QuickDASH Score65.88 ± 3.2646.18 ± 2.3123.91 ± 1.168.52 ± 0.42
      VAS Score7.66 ± 0.385.33 ± 0.263.47 ± 0.172.09 ± 0.11
      p-value<0.01∗<0.01∗<0.01∗<0.01∗
      Quick DASH – Disabilities of Shoulder and Hand.
      VAS - Visual Analog Scale.
      p-value <0.05 – statistically significant∗.
      Table 3Comparison of pre-operative and post-operative (one year follow-up) range of motion.
      Joint ROM (flexion)Pre-operativePost-operative (one year)
      MCP Joint52.85 ± 0.2672.38 ± 0.37
      PIP Joint10.47 ± 0.1270.47 ± 0.36
      DIP Joint38.33 ± 0.1962.38 ± 0.32
      p-value<0.01∗<0.01∗
      ROM – Range of motion.
      MCP – Metacarpophalangeal.
      PIP – Proximal Interphalangeal.
      DIP – Distal Interphalangeal.
      p-value <0.05 – statistically significant∗.
      Superficial wound infection was noted in one subject. It was managed with oral antibiotics. Swelling at the donor site was noted in two patients. Radiographs of the site did not show any abnormality. The swelling subsided within a week after being treated with anti-inflammatory medications. In one case, an iatrogenic fracture of the dorsal cortex of the middle phalanx base was noted. No additional intervention was done for the same as the hand and wrist were immobilized post-surgery. Follow-up radiographs in one case showed changes suggestive of avascular necrosis involving the head of the proximal phalanx of the involved digit. As the patient was asymptomatic and had an adequate range of motion of the involved digit, he was managed conservatively.

      4. Discussion

      PIP joint fracture-dislocations are challenging cases, the ideal treatment for which includes restoration of the joint congruity and early re-establishment of the range of motion.
      • Kiefhaber T.R.
      • Stern P.J.
      Fracture dislocations of the proximal interphalangeal joint.
      Surgical options including ORIF, VPA, and external fixation have been tried for the management of dorsal PIP fracture-dislocations of higher grades, but hemi-hamate arthroplasty is more advantageous for managing this difficult fracture pattern. VPA is usually successful when the fracture-dislocation involves less than 50% of the articular surface
      • Burnier M.
      • Awada T.
      • Marin Braun F.
      • Rostoucher P.
      • Ninou M.
      • Erhard L.
      Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts.
      with the redislocation risk increasing when more than 50% of the articular surface is involved. Moreover, as the outcome is poorer when injuries more than six weeks old are dealt with VPA,
      • Arsad S.R.
      • Sem S.H.
      • Silvanathan J.P.
      • Muhammad Nawawi R.F.
      Hemi-hamate arthroplasty in chronic fracture-dislocation of proximal interphalangeal joint of fingers: a report of two cases.
      hemi-hamate arthroplasty is the preferred modality for the management of chronic PIP joint fracture-dislocations. ORIF is difficult in the case of articular comminution.
      • Lee J.Y.
      • Teoh L.C.
      Dorsal fracture dislocations of the proximal interphalangeal joint treated by open reduction and interfragmentary screw fixation: indications, approaches and results.
      The present study evaluated the functional outcomes of hemi-hamate arthroplasty when used for the management of chronic PIP joint fracture-dislocations.
      A traction system using three pins has been described by Robertson et al. for the conservative management of these cases.
      • Robertson R.C.
      • Cawley Jr., J.J.
      • Faris A.M.
      Treatment of fracture-dislocation of the interphalangeal joints of the hand.
      Although union occurred with its use, the failure to restore the congruity of the joint resulted in persistent stiffness. Wilson and Rowland introduced a method of reducing these fractures by open techniques followed by internal fixation.
      • Wilson J.N.
      • Rowland S.A.
      Fracture-dislocation of the proximal interphalangeal joint of the finger.
      In their series of 15 patients, an average of 74° of range of motion at the PIP joint was seen. The technique of volar plate arthroplasty was described in 1980
      • Eaton R.G.
      • Malerich M.M.
      Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years' experience.
      and it involved the removal of the comminuted fracture fragments involving the middle phalanx volar base followed by advancing the volar plate into the bony defect to restore the volar buttress. However, this was associated with a risk of dorsal subluxation that was proportional to the extent of comminution.
      • Deitch M.A.
      • Kiefhaber T.R.
      • Comisar B.R.
      • Stern P.J.
      Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results.
      Ishida et al. introduced a technique of osteochondral grafting for restoring the damaged PIP joint.
      • Ishida O.
      • Ikuta Y.
      • Kuroki H.
      Ipsilateral osteochondral grafting for finger joint repair.
      However, it was associated with only a moderate improvement in the range of motion. The use of a hemi-hamate autograft obtained from the distal aspect of the hamate for the reconstruction of these injuries was described in a series of five patients by Hastings et al.
      • Williams R.M.
      • Kiefhaber T.R.
      • Sommerkamp T.G.
      • Stern P.J.
      Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft.
      The mean articular involvement in this series was 73% and the arc of motion of the PIP joint was 77°. The grip strength was 81% as compared to the uninjured side with union seen in all cases. In a study involving 56 PIP fracture-dislocations that were managed surgically, redislocation was seen in six cases of which three were managed with ORIF and three with VPA.
      • Deitch M.A.
      • Kiefhaber T.R.
      • Comisar B.R.
      • Stern P.J.
      Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results.
      Another review concluded that ORIF was best for fractures with simple patterns because the range of motion of the PIP joint decreased as the number of involved fracture fragments increased.
      • Hamilton S.C.
      • Stern P.J.
      • Fassler P.R.
      • Kiefhaber T.R.
      Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations.
      Williams et al. stated that reattaching the volar plate along with hemi-hamate arthroplasty was recommended as it acted as an additional stabilizer.
      • Williams R.M.
      • Kiefhaber T.R.
      • Sommerkamp T.G.
      • Stern P.J.
      Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft.
      They also concluded that this procedure was technically challenging and should be initially practiced in cadavers because of its learning curve.
      The hamate cannot guarantee complete restoration of the articular surface and thus the aim of surgery should be the restoration of the volar buttress. Although complete restoration of the preoperative range of motion is difficult, HHA can lead to restoration of motion that would not lead to any limitation in performing activities of daily living. The findings of our study were comparable to previously described studies (Table 4). The highlight of the study was that all the cases managed were chronic injuries. There are not many studies focusing exclusively on chronic PIP joint injuries. As this study was conducted during COVID-19, most of the patients were not able to seek timely treatment due to the imposed restrictions, thereby leading to a delay in presentation. Limitations of our study included the retrospective nature, smaller sample size, and the comparatively lesser duration of follow-up. Attrition was a major problem due to the COVID-19 pandemic restrictions and hence, the follow-up duration was lesser.
      Table 4Review of literature and comparison of the present study with previously published studies.
      AuthorsYearSample sizeMean time to surgeryPost op PIP ROMPost op DIP ROMGrip strength (% of normal side)Mean follow up post-surgery (in months)DASH/Quick DASH at latest follow-upVAS at latest follow-up
      Williams
      • Williams R.M.
      • Kiefhaber T.R.
      • Sommerkamp T.G.
      • Stern P.J.
      Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft.
      20031345 days85°60°80%161.3
      Calfee
      • Calfee R.P.
      • Kiefhaber T.R.
      • Sommerkamp T.G.
      • Stern P.J.
      Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture-dislocations.
      200922 (14 acute injuries, 8 chronic injuries)70°54°95%5451.4
      Lindenblatt
      • Lindenblatt N.
      • Biraima A.
      • Tami I.
      • Giovanoli P.
      • Calcagni M.
      Hemi-hamate autograft arthroplasty for acute and chronic PIP joint fracture dislocations.
      201310 (5 acute injuries, 5 chronic injuries)93 days71°54°95%8.6
      Burnier
      • Burnier M.
      • Awada T.
      • Marin Braun F.
      • Rostoucher P.
      • Ninou M.
      • Erhard L.
      Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts.
      201619 (9 acute injuries, 10 chronic injuries)83°41°82%24111.1
      Goon
      • Goon P.K.Y.
      • Vaghela K.R.
      • Stougie S.
      • Coert J.H.
      Hemi-hamate autograft arthroplasty for the proximal interphalangeal joint revisited: a new surgical approach.
      2017418 months (548 days)76°190
      Verdins
      • Verdins K.
      • Nefjodovs V.
      Outcomes of the hemi-hamatum arthroplasty.
      20191139 days82.2°68.9°90%436.90.6
      Malhotra
      • Malhotra G.
      • Al Bahri Z.H.
      • Elsayed A.O.A.
      • Komma V.N.R.
      • Patil R.
      Hemihamate arthroplasties in pilon fractures: a modified approach and experience in 30 patients.
      202130104°28
      Present study202221 (all chronic injuries)9.4 weeks (66 days)70°62°90%1282
      Quick DASH – Disabilities of Shoulder and Hand.
      VAS - Visual Analog Scale.
      ROM – Range of motion.
      PIP – Proximal Interphalangeal.
      DIP – Distal Interphalangeal.

      5. Conclusion

      Hemi-hamate arthroplasty is a very good technique for the management of chronic PIP fracture-dislocations involving more than 50% of the articular surface. Although the technique has a longer learning curve, it is associated with favorable outcomes when performed well and when coupled with supervised dedicated physiotherapy as part of the post-operative protocol.

      Funding

      The author(s) received NO financial support for the preparation, research, authorship, and/or publication of this manuscript.

      Declaration of informed consent

      There is no information (names, initials, hospital identification numbers or photographs) in the submitted manuscript that can be used to identify patients.

      Author statement

      Prashant Kamble: Conceptualization, Methodology. Rudra Mangesh Prabhu: Data curation, Writing- Original draft preparation. Shubhranshu Mohanty: Supervision, Validation. Swapnil Keny- Reviewing and Editing.

      Declaration of competing interest

      The Authors declare that there is no conflict of interest.

      Acknowledgements

      None.

      References

        • Elfar J.
        • Mann T.
        Fracture-dislocations of the proximal interphalangeal joint.
        J Am Acad Orthop Surg. 2013; 21: 88-98https://doi.org/10.5435/JAAOS-21-02-88
        • Dionysian E.
        • Eaton R.G.
        The long-term outcome of volar plate arthroplasty of the proximal interphalangeal joint.
        J Hand Surg Am. 2000; 25: 429-437https://doi.org/10.1016/s0363-5023(00)70026-8
        • Kiefhaber T.R.
        • Stern P.J.
        Fracture dislocations of the proximal interphalangeal joint.
        J Hand Surg Am. 1998; 23: 368-380https://doi.org/10.1016/S0363-5023(05)80454-X
        • Hastings 2nd, H.
        • Carroll 4th, C.
        Treatment of closed articular fractures of the metacarpophalangeal and proximal interphalangeal joints.
        Hand Clin. 1988; 4: 503-527
        • Williams R.M.
        • Kiefhaber T.R.
        • Sommerkamp T.G.
        • Stern P.J.
        Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft.
        J Hand Surg Am. 2003; 28: 856-865https://doi.org/10.1016/s0363-5023(03)00304-6
        • Deitch M.A.
        • Kiefhaber T.R.
        • Comisar B.R.
        • Stern P.J.
        Dorsal fracture dislocations of the proximal interphalangeal joint: surgical complications and long-term results.
        J Hand Surg Am. 1999; 24: 914-923https://doi.org/10.1053/jhsu.1999.0914
        • Burnier M.
        • Awada T.
        • Marin Braun F.
        • Rostoucher P.
        • Ninou M.
        • Erhard L.
        Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts.
        J Hand Surg Eur. 2017; 42: 188-193https://doi.org/10.1177/1753193416671886
        • Arsad S.R.
        • Sem S.H.
        • Silvanathan J.P.
        • Muhammad Nawawi R.F.
        Hemi-hamate arthroplasty in chronic fracture-dislocation of proximal interphalangeal joint of fingers: a report of two cases.
        Cureus. 2020; 12 (Published 2020 Jan 22)e6735https://doi.org/10.7759/cureus.6735
        • Lee J.Y.
        • Teoh L.C.
        Dorsal fracture dislocations of the proximal interphalangeal joint treated by open reduction and interfragmentary screw fixation: indications, approaches and results.
        J Hand Surg Br. 2006; 31: 138-146https://doi.org/10.1016/j.jhsb.2005.09.019
        • Robertson R.C.
        • Cawley Jr., J.J.
        • Faris A.M.
        Treatment of fracture-dislocation of the interphalangeal joints of the hand.
        J Bone Joint Surg Am. 1946; 28: 68-70
        • Wilson J.N.
        • Rowland S.A.
        Fracture-dislocation of the proximal interphalangeal joint of the finger.
        J Bone Joint Surg Am. 1966; 48: 493-502
        • Eaton R.G.
        • Malerich M.M.
        Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years' experience.
        J Hand Surg Am. 1980; 5: 260-268https://doi.org/10.1016/s0363-5023(80)80011-6
        • Ishida O.
        • Ikuta Y.
        • Kuroki H.
        Ipsilateral osteochondral grafting for finger joint repair.
        J Hand Surg Am. 1994; 19: 372-377https://doi.org/10.1016/0363-5023(94)90048-5
        • Hamilton S.C.
        • Stern P.J.
        • Fassler P.R.
        • Kiefhaber T.R.
        Mini-screw fixation for the treatment of proximal interphalangeal joint dorsal fracture-dislocations.
        J Hand Surg Am. 2006; 31: 1349-1354https://doi.org/10.1016/j.jhsa.2006.07.011
        • Calfee R.P.
        • Kiefhaber T.R.
        • Sommerkamp T.G.
        • Stern P.J.
        Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture-dislocations.
        J Hand Surg Am. 2009; 34: 1232-1241https://doi.org/10.1016/j.jhsa.2009.04.027
        • Lindenblatt N.
        • Biraima A.
        • Tami I.
        • Giovanoli P.
        • Calcagni M.
        Hemi-hamate autograft arthroplasty for acute and chronic PIP joint fracture dislocations.
        Handchir Mikrochir Plast Chir. 2013; 45: 13-19https://doi.org/10.1055/s-0033-1337917
        • Goon P.K.Y.
        • Vaghela K.R.
        • Stougie S.
        • Coert J.H.
        Hemi-hamate autograft arthroplasty for the proximal interphalangeal joint revisited: a new surgical approach.
        J Hand Surg Asian Pac. 2018; 23: 297-301https://doi.org/10.1142/S2424835518710029
        • Verdins K.
        • Nefjodovs V.
        Outcomes of the hemi-hamatum arthroplasty.
        J Hand Surg Asian Pac. 2019; 24: 342-346https://doi.org/10.1142/S2424835519500437
        • Malhotra G.
        • Al Bahri Z.H.
        • Elsayed A.O.A.
        • Komma V.N.R.
        • Patil R.
        Hemihamate arthroplasties in pilon fractures: a modified approach and experience in 30 patients.
        J Hand Surg Eur. 2021; 46: 928-935https://doi.org/10.1177/17531934211008056