Hemi-capitate arthroplasty for chronic unstable dorsal fracture-dislocations of the proximal interphalangeal joint: A retrospective analysis of functional and radiological outcomes.

BACKGROUND

This retrospective study examined the clinical and radiological outcomes of hemi-capitate arthroplasty in treating chronic unstable dorsal fracture-dislocations of the proximal interphalangeal (PIP) joint.

METHODS

Fifteen patients, aged 22-36 years, who underwent hemi-capitate arthroplasty for chronic unstable dorsal PIP joint fracture-dislocations between 2020 and 2022, were included in this review. Thirteen patients had nondominant hand involvement. Clinical outcomes were evaluated by assessing PIP joint range of motion (ROM), grip strength, pain using the Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores. Radiographic evaluations focused on posttraumatic arthritis, graft integrity, and joint stability.

RESULTS

The average time from injury to surgery was 79 days (range: 45-125 days), with a mean follow-up of 23 months (range: 18-36 months). At the final follow-up, the mean PIP joint ROM significantly improved from 3° preoperatively to 95° postoperatively (p < 0.05), with a motion arc between 85° and 105°. The mean extension lag was 2° (range: 0°-10°). Postoperative grip strength reached 92 % (range: 78 %-100 %) of the contralateral hand. The QuickDASH score improved to a mean of 5.5 (range: 0-13.3), and mean pain score was low (mean VAS: 0.2, range: 0-4). Based on the Ishida and Ikuta scoring system, 13 patients had excellent outcomes. No patients developed postoperative osteoarthritis, graft collapse, donor-site problems, or wrist pain. Three patients had a mild extensor lag (approximately 10°), but all patients had returned to their previous activities by an average of 13 weeks (range: 11-16 weeks) after surgery.

CONCLUSIONS

Hemi-capitate arthroplasty consistently yielded positive functional and radiological outcomes in chronic unstable dorsal PIP joint fracture-dislocations. This technique effectively restores joint stability and a substantial range of motion, allowing patients to resume daily activities with few complications.