Injury on PIP of right index finger

[msilva913]

Dr. Tomaino:

A few days ago, my mother Adriana asked you if you thought hemi-hamate arthroplasty could be appropriate for a severe injury I have on the PIP of the index. You responded that based on the x-rays, the only options were fusion or replacement (and that fusion was the better option).

The reason I ask is that a hand surgeon at Stanford, Jefferey Yao, said the hemi-hamate arthroplasty was a risky option that might preserve most mobility on my right index finger. The issue is that I have substantial arthritis and deviation on the finger--but I have more than 90 degrees of mobility.

I certainly understand that a fusion is definitely the "standard" procedure to use in such a situation, but given that it eliminates motion on the joint for life, I was wondering if some argument could be made for trying this procedure--with fusion as the strategy if it fails.

I understand several reasons why the procedure might not work: the overstretched collateral ligament might cause the bone to deviate; the bone from the wrist would have to bind from an articular surface.

So, is realigning and stabilizing the joint with hemi-hamate arthroplasty something of a possibility, or is it crazy? Furthermore, if the joint could be succcessfully realigned and stabilized, would this be enough to kill off most pain--enough to where writing is not problematic--or does the damage to the articular cartilage mean that much pain could remain even with realignment? (I am not talking about eliminating all pain, just enough so that writing is not an issue--since this is my writing finger).


These are tough questions. Any insights would be super, super appreciated!!

Thank you.