Hemihamate arthroplasties in pilon fractures: a modified approach and experience in 30 patients

Hemihamate arthroplasty is an established method of managing difficult Pilon fractures of the proximal interphalangeal (PIP) joint. We present our experience in 30 patients, whose injuries were further complicated by severe comminution and late presentations. Several modifications were utilized, including preoperative distraction, use of smaller size grafts and functional release of collaterals. The average follow-up period was 28 months (range 18 to 28). Postoperatively, the average range of flexion at the PIP joint improved from 30° (range 20° to 45°) preoperatively to 104° (90° to 110°) at the final follow-up. The average extension lag was 6° (0° to 20°). Five patients required secondary procedures and no patient had a recurrent dorsal dislocation. We propose these modifications in the use of hemihamate arthroplasty for the management of difficult PIP joint fractures.Level of evidence: IV.

Release of Extensive Post Traumatic Radio-Ulnar Synostosis with Vascularized Free Flap Interposition

Radioulnar synostosis is a rare complication after a forearm or elbow injury. The severity of initial trauma, associated head injury along with timing and the type of surgical treatment have been implicated in the formation of extra bone leading to synostosis. Surgical intervention is the standard treatment and is recommended after the maturation of synostotic bone. Surgery involves resection of the extra bone with or without tissue interposition. Materials used for interposition may include synthetic materials, allografts, and vascularized and non-vascularized autologous tissue superiority of one material over the other has not been demonstrated. Reported is a case of extensive soft-tissue defect and severe type II synostosis, with a relevant review of the literature. Level of Evidence Level IV.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s43465-021-00395-5.

Functional Outcome Following Hand and Wrist Level Replantation: A Retrospective Review

Objective: Amputations of fingers and significant parts of upper limbs are common following industrial injuries. This study was aimed at assessing the functional outcome in patients with hand replantation following amputation at the level of distal forearm or wrist. Methods: Patients presenting with amputation at the level of wrist and forearm between Jan 2015 and December 1018, with adequate follow up were included. The function in terms of total active motion at the fingers and wrist, sensory recovery, and patient satisfaction and DASH scores at the final follow up were noted. Results: Four cases of replantation at the level of wrist and one replantation at distal forearm level were included in the study. A total of 3 patients were excluded for various reasons. The average follow-up period was 38 months. The average total active motion of fingers achieved was 212○ . All patients recovered protective sensations. Conclusion: Replantation of amputated major upper limb parts restores useful function and should be attempted. Minimizing ischaemia time, secure fixation, primary repair of structures and early motion are determinants of reasonable functional outcome. Level of evidence: IV.