Williams Rafael M M, Hastings Hill, Kiefhaber Thomas R
Cincinnati Hand Surgery Specialists, Cincinnati, Ohio, U.S.A. The Indiana Hand Center, Indianapolis, Indiana, U.S.A. Cincinnati Hand Surgery Specialists, Cincinnati, Ohio, U.S.A.
Tech Hand Up Extrem Surg. 2002 Dec;6(4):185-92. doi: 10.1097/00130911-200212000-00005.
The nature of injury following a PIP fracture dislocation is determined by the direction of force transmission and the position of the joint at the time of impact. Dorsal dislocations with palmar lip fractures are the most frequently encountered and can be classified based on stability. The degree of stability is directly determined by the amount of middle phalangeal palmar lip involvement; the larger the palmar lip fracture, the more unstable the joint becomes. When there is persistent instability or greater than 30 degrees of flexion is required to maintain reduction, treatment must be aimed at reconstituting the cup shaped geometry and buttressing effect of the volar lip of the middle phalanx if stability is to be restored. The use of a hemi-hamate autograft to reconstruct the base of the middle phalanx is a new technique that restores joint congruity and stability while allowing for early motion. This operative technique replaces the damaged palmar lip of the middle phalanx with a size-matched portion of the hamate obtained from its distal dorsal articular surface between the 4th and 5th metacarpals. By restoring both articular congruity and osseous stability the advantage of this procedure is that it allows more immediate rehabilitation with a potential for earlier motion, less stiffness and possibly less post-traumatic arthritis.
近端指间关节（PIP）骨折脱位后的损伤性质取决于力的传导方向以及撞击时关节的位置。伴有掌侧唇骨折的背侧脱位最为常见，可根据稳定性进行分类。稳定性程度直接由中节指骨掌侧唇受累程度决定；掌侧唇骨折越大，关节越不稳定。当存在持续不稳定或需要大于30度的屈曲来维持复位时，如果要恢复稳定性，治疗必须旨在重建中节指骨掌侧唇的杯状几何结构和支撑作用。使用半钩骨自体移植物重建中节指骨基底是一种新技术，可恢复关节的一致性和稳定性，同时允许早期活动。这种手术技术用从第4和第5掌骨之间的钩骨远端背侧关节面获取的尺寸匹配部分替换受损的中节指骨掌侧唇。通过恢复关节一致性和骨稳定性，该手术的优点是允许更直接的康复，有可能更早活动，减少僵硬，并且可能减少创伤后关节炎。
