Osteochondral Autograft From the Hamate for Treating Partial Defect of the Proximal Interphalangeal Joint

Junxi Dai; Yuze Zheng; Chaoqun Yang; Lingchun Wang; Yu Cao; Lei Xu; Jianguang Xu; Jiuzhou Lu

doi:10.1016/j.jhsa.2021.11.007

Osteochondral Autograft From the Hamate for Treating Partial Defect of the Proximal Interphalangeal Joint

J Hand Surg Am. 2023 Apr;48(4):404.e1-404.e10. doi: 10.1016/j.jhsa.2021.11.007. Epub 2022 Jan 10.

Authors

Junxi Dai¹, Yuze Zheng², Chaoqun Yang¹, Lingchun Wang³, Yu Cao¹, Lei Xu¹, Jianguang Xu⁴, Jiuzhou Lu⁵

Affiliations

¹ Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.
² Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
³ Department of Hand and Foot Surgery, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.
⁴ Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China; School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China. Electronic address: xjg@shutcm.edu.cn.
⁵ Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China. Electronic address: lujiuzhou@hotmail.com.

PMID: 35027264
DOI: 10.1016/j.jhsa.2021.11.007

Abstract

Purpose: The management of a proximal interphalangeal (PIP) joint fracture dislocation becomes more challenging when the joint surface is damaged because of severe comminution or inadequate treatment in the acute phase. The purpose of this study was to evaluate the clinical outcomes of an osteochondral autograft for the reconstruction of the joint surface in patients with a partial PIP joint defect.

Methods: Twelve patients underwent osteochondral autograft surgery from May 2007 to July 2018. The average age at the time of surgery was 38 years (range, 21-67 years), and there were 10 men and 2 women. Plain radiographs and computed tomography scans showed a partial middle phalangeal base defect in all the cases. The surgeries were performed 2 weeks to 20 months after the fracture or a previous surgery. Partial hamate grafts were harvested to reconstruct volar lip (n = 7), middle portion (n = 2), and dorsal lip (n = 3) defects of the middle phalangeal base. Bone healing, postoperative range of motion, instability, and pain were evaluated. The average follow-up duration was 27.8 months (range, 12-53 months).

Results: Radiographic graft union was observed in all the patients 6-8 weeks after the surgery. The deformity was corrected in 11 patients. The active range of motion of the involved PIP joint was improved from 28.3° (range, 0°-60°) to 75.0° (range, 25°-95°). Complications were observed during follow-up, including degenerative arthritis (n = 2), instability (n = 3), and stiffness (n = 5).

Conclusions: Various types of partial joint defects of the middle phalangeal base following a PIP fracture dislocation can be reconstructed using an osteochondral autograft from the hamate. The functional recovery is generally acceptable, with a well-restored joint architecture.

Type of study/level of evidence: Therapeutic IV.

Keywords: External fixator; osteochondral bone graft; partial defect; proximal interphalangeal joint.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Autografts
Female
Finger Injuries* / surgery
Finger Joint / surgery
Finger Phalanges* / surgery
Fracture Dislocation*
Hamate Bone* / transplantation
Humans
Intra-Articular Fractures* / surgery
Joint Dislocations* / surgery
Male
Middle Aged
Range of Motion, Articular
Retrospective Studies
Young Adult