Fifth metacarpal instability and its effect on hamatometacarpal arthritis patterns–a cadaver study

Hemi-hamate donor site morbidity and complications: a systematic review

Background

The hemi-hamate arthroplasty is utilised for the management of complex fracture-dislocations for injuries of the proximal interphalangeal joints (PIPJ) of the fingers. PIPJ outcomes are well described, including the post-operative range of motion, grip strength and osteochondral graft union. However, there is a paucity of evidence analysing the rate of donor site morbidity and complications. This systematic review aims to present the published morbidity of the donor site for the hemi-hamate arthroplasty.

Methods

A search was conducted in MEDLINE, Embase, Emcare, CINAHL and ProQuest Nursing and Allied Health databases from their inception which yielded 384 articles to be screened. Pertinent anatomy, harvesting techniques and post-operative donor site care of the hemi-hamate arthroplasty is reviewed.

Results

One hundred three cases of hemi-hamate arthroplasty were included in this review with seven (6.8%) complications presented, one of which required operative intervention.

Conclusion

Donor site morbidity resulting from harvesting an osteochondral graft for a hemi-hamate arthroplasty is low. The overall quality of evidence from the studies in this review is low, highlighting the need for further robust prospective trials.

Level of evidence

Not gradable.

Intermetacarpal M4-M5 arthrodesis (Dubert procedure) for fifth carpometacarpal joint osteoarthritis: long-term functional outcomes

The goal of this study was to describe the long-term functional outcomes of the procedure described by Dubert (stabilized arthroplasty with intermetacarpal arthrodesis) for painful carpometacarpal impingement of the little finger. Between 2005 and 2017, 8 patients (1 woman and 7 men) were operated on who had a mean age of 38 years (24-53 years). Seven cases were post-traumatic (malunion) and one was due to septic arthritis. A total of 5 patients were available for a retrospective clinical, functional, and radiological follow-up at a mean of 73 months (23-108 months). Clinical parameters included pain on VAS, grip strength, Quick Disability of Arm, Shoulder and Hand questionnaire, Patient-Rated Wrist Evaluation, and a subjective hand value (0-100%). Fusion was achieved in all cases. Of the 8 patients, one developed complex regional pain syndrome and one had persistent pain that required secondary proximal metacarpal resection. At the last follow-up, all patients were satisfied and reported a significant reduction in pain and improvement in strength. Mean Quick Disability of Arm, Shoulder, and Hand questionnaire, Patient-Rated Wrist Evaluation and subjective hand value were 19/100 points, 21/100 points and 75%, respectively. Our study suggests that the stabilized arthroplasty of the fifth finger, as describe by Dubert, is an efficient and reliable method to reduce pain and improve hand function in patients suffering from carpometacarpal impingement of the little finger. LEVEL OF EVIDENCE: retrospective series, IV.