A Modification to Simplify the Harvest of a Hemi-hamate Autograft

Abstract

Hemi-hamate arthroplasty is a valuable option for subacute dorsal fracture-dislocations of the proximal interphalangeal joint. Various harvesting techniques have been recommended via both anterograde and retrograde directions, both posing some technical challenges. We propose a technique for simplifying the hemi-hamate graft harvest by creating a window of visualization onto the dorsal hamate articular surface. This is achieved by resection of the dorsal-ulnar base of fourth metacarpal and the dorsal-radial base of the fifth metacarpal. This makes it easier to measure and cut the hamate articular surface. It also provides a properly shaped graft that can be inset in the middle phalangeal defect without using backgrafting, and allowing screws to be placed perpendicular to the graft defect to obtain direct compression.

Keywords: Graft; PIP fracture-dislocation; harvest; hemi-hamate; reconstruction.