Jerome J Terrence Jose
European Diploma Hand Surgery, Department of Orthopedics, Hand and Reconstructive Microsurgery, Olympia Hospital & Research Centre, 47, 47A Puthur High Road, Puthur, Trichy, Tamilnadu, Pin code 620017, India.
J Clin Orthop Trauma. 2025 Apr 18;66:103020. doi: 10.1016/j.jcot.2025.103020. eCollection 2025 Jul.
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.
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.
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.
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.
本回顾性研究探讨了半头状骨置换术治疗近端指间关节（PIP）慢性不稳定背侧骨折脱位的临床和影像学结果。
本综述纳入了15例年龄在22至36岁之间、于2020年至2022年期间因PIP关节慢性不稳定背侧骨折脱位接受半头状骨置换术的患者。其中13例患者受累手为非优势手。通过评估PIP关节活动范围（ROM）、握力、使用视觉模拟量表（VAS）评估疼痛以及上肢、肩部和手部快速残疾评定量表（QuickDASH）评分来评估临床结果。影像学评估重点关注创伤后关节炎、移植物完整性和关节稳定性。
受伤至手术的平均时间为79天（范围：45至125天），平均随访23个月（范围：18至36个月）。在最后一次随访时，PIP关节平均ROM从术前的3°显著提高到术后的95°（p < 0.05），活动弧度在85°至105°之间。平均伸展滞后为2°（范围：0°至10°）。术后握力达到对侧手的92%（范围：78%至100%）。QuickDASH评分平均提高到5.5（范围：0至13.3），平均疼痛评分较低（平均VAS：0.2，范围：0至4）。根据石田和生田评分系统，13例患者结果优秀。无患者发生术后骨关节炎、移植物塌陷、供区问题或腕部疼痛。3例患者有轻度伸肌滞后（约10°），但所有患者术后平均13周（范围：11至16周）均恢复了之前的活动。
半头状骨置换术在治疗PIP关节慢性不稳定背侧骨折脱位方面始终产生积极的功能和影像学结果。该技术有效恢复关节稳定性和大幅度活动范围，使患者能够恢复日常活动且并发症较少。
