Evaluation of Articular Surface Similarity of Hemi-Hamate Grafts and Proximal Middle Phalanx Morphology: A 3D Geometric Morphometric Approach

Purpose: Hemi-hamate arthroplasty has been described as a viable treatment option for unstable proximal interphalangeal joint fracture-dislocations. The procedure uses a dorsal distal hamate osteochondral graft to recreate the injured volar middle phalanx (MP) proximal base. The purpose of this study was to evaluate the similarity in shape of these articular surfaces using quantitative 3-dimensional methods.

Methods: Three-dimensional virtual renderings were created from laser scans of the articular surfaces of the dorsal distal hamate and the volar MP bases of the index, middle, ring, and little fingers from cadaveric hands of 25 individuals. Three-dimensional landmarks were obtained from the articular surfaces of each bone and subjected to established geometric morphometric analytical approaches to quantify shape. For each individual, bone shapes were evaluated for covariation using 2-block partial least-squares and principal component analyses.

Results: No statistically significant covariation was found between the dorsal distal hamate and volar MP bases of the middle, ring, or little digits. Whereas the volar MP bases demonstrated relative morphologic uniformity among the 4 digits both within and between individuals, the dorsal distal hamates exhibited notable variation in articular surface morphology.

Conclusions: Despite the early to midterm clinical success of hemi-hamate arthroplasty, there is no statistically significant, uniform similarity in shape between the articular surfaces of the dorsal distal hamate and the volar MP base. In addition, there is wide variation in the articular morphology of the hamate among individuals.

Clinical relevance: The lack of uniform similarity in shape between the dorsal distal hamate and the volar MP base may result in unpredictable outcomes in HHA. It is recommended that the variation in hamate morphology be considered while reconstructing the injured volar MP base in the procedure.