|This case demonstrates the use of the gull-wing shaped hamate articular graft for replacement of loss of the palmar half of the distal phalanx articular surface from a DIP dorsal fracture-dislocation. This is analogous to the HHRA reconstruction described for PIP fracture dislocation ( Case 1, Case 2, Case 3, Article ) , but because of differences in anatomy, has been performed through a bayonette exposure rather than the traditional PIP shotgun exposure. One goal of this exposure is to allow immediate postoperative motion by avoiding the need to perform a tenotomy to expose the joint.
|Click on each image for a larger picture
|The injury:dorsal DIP fracture dislocation of the ring finger of a 16 year old male sports hopeful.
|Unstable even in a well molded splint.
|Custom articular osteotome designed to create an intraarticular osteotomy through the distal hamate surface, a bit easier to control than a Freer elevator.
|Intraoperative fluoros: The injury, reconstruction through a bayonette exposure, stable reduction.
Collateral ligaments take down
Dorsal dislocation "Bayonette" exposure
Graft harvest from ring-small juncture of hamate
Provisional fixation with Kwires through extensor tendon
Replace Kwires with screws
|Technical note regarding
closure: the eponychial wound has two skin layers: superficial and
deep. If they are not closed separately, the closure will heal with
prolonged inflammation. This can usually be prevented with a
layered closure using a deep pullout suture, as shown here:
|Three months postop, following a program of immediate protected motion supervised in therapy. No pain, full flexion, 20 degree extensor lag, ready for sports.
interphalangeal fracture dislocation
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