PURPOSE: To evaluate the early clinical and radiographic outcomes of hemi-hamate autograft (HHA) reconstruction for unstable dorsal proximal interphalangeal joint (PIPJ) fracture-dislocations with severe comminution involving more than 50% loss of the volar articular surface.
METHODS: A retrospective case series of 4 patients treated with HHA reconstruction between June and December 2025 was performed. All injuries involved highly comminuted fractures that were unsuitable for conventional open reduction and internal fixation. The surgical technique aimed to restore the volar buttress of the middle phalanx using an osteochondral hamate graft fixed with bicortical lag screws. Early protected active motion was initiated within the first postoperative days using a dorsal extension-block splint. Clinical outcomes included active PIPJ range of motion, grip, and key pinch strength relative to the contralateral side, visual analog scale pain score, and Disabilities of the Arm, Shoulder and Hand score. Radiographic assessments evaluated joint alignment and graft integration.
RESULTS: At 3-6 months, the mean active PIPJ arc of motion was 81.8° ± 7.9°. Grip strength recovered to 86% ± 5% of the contralateral side. The mean Disabilities of the Arm, Shoulder and Hand score improved from 38.3 ± 6.3 at 6 weeks to 7.5 ± 4.0 at final follow-up. Pain was minimal, with a mean visual analog scale score of 0 at rest and 0.5 during motion. Radiographs demonstrated maintained concentric reduction and successful graft incorporation in all cases without hardware complications or donor-site morbidity.
CONCLUSIONS: In this small case series, HHA reconstruction showed promising early functional outcomes for delayed, severe dorsal PIPJ fracture-dislocations. Further studies with larger cohorts and longer follow-up are needed to confirm these results.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
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