Skip to main content

Advertisement

SpringerLink
Log in

The vascular basis of the hemi-hamate osteochondral free flap. Part 1: vascular anatomy and clinical correlation

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

The treatment of comminuted fractures of the proximal interphalangeal joint is highly challenging due to the complexities of joint bio-mechanics and stability. The hemi-hamate osteochondral auto-graft has been popularised in this role, able to replace articular loss and restore joint stability. Recent evaluation of their long-term follow-up however has shown the early development of osteoarthritis and potential early cartilage loss, which may be due to the non-vascularised nature of the graft. We offer a new technique that maintains vascularisation of the transferred hamate fragment, and investigate the anatomical vascular basis for the technique.

Methods

Dissection and angiographic studies of ten cadaveric specimens were undertaken, exploring the vascular anatomy of the dorsal hamate. A clinical case of hemi-hamate osteochondral free flap is presented, including preoperative, intraoperative and postoperative investigation of the relevant vasculature.

Results

Cadaveric studies demonstrated dorsal vascular supply to the hamate from the central of three dorsal carpal arches. The arch was supplied by the dorsal branch of the ulnar artery. Multiple supracapsular veins are present for use in flap venous drainage. This vascular pattern was found to be constant. A clinical case of hemi-hamate osteochondral free flap harvest demonstrated the same vascular anatomy intraoperatively. The digital artery was used as a recipient for microvascular anastomosis. Postoperative computed tomographic angiography and nuclear bone scan confirmed flap perfusion.

Conclusions

The hemi-hamate osteochondral flap has a reliable anatomical vascular basis, and is clinically feasible as a technique for early vascularisation of the osteochondral fragment to sustain the transferred articular cartilage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Afendras G, Abramo A, Mrkonjic A et al (2010) Hemi-hamate osteochondral transplantation in proximal interphalangeal dorsal fracture dislocations: a minimum 4 year follow-up in eight patients. J Hand Surg 35E:627–631

    Google Scholar 

  2. Berg PT, Ring D (2012) Quantitative 3D-CT anatomy of hamate osteoarticular autograft for reconstruction of the middle phalanx base. Clin Orthop. doi:10.1007/s11999-012-2372-x

    PubMed  Google Scholar 

  3. Botte MJ, Pacelli LL, Gelberman RH (2004) Vascularity and osteonecrosis of the wrist. Orthop Clin N Am 35:405–421

    Article  Google Scholar 

  4. Calfee RP, Kiefhaber TR, Sommerkamp TG et al (2009) Hemi-hamate arthroplasty provides functional reconstruction of acute and chronic proximal interphalangeal fracture-dislocations. J Hand Surg 34A:1232–1341

    Google Scholar 

  5. Capo JT, Hasting H, Choung E (2008) Hemicondular hamate replacement arthroplasty for proximal interphalangeal joint fracture dislocations: as assessment of graft suitability. J Hand Surg 33A:733–739

    Google Scholar 

  6. Chinchalkar SJ, Gan BS (2003) Management of proximal interphalangeal joint fractures and dislocations. J Hand Ther 16:117–128

    Article  PubMed  Google Scholar 

  7. Del Pinal F, Gracia-Bernal FJ, Delgado J et al (2005) Reconstruction of the distal radius facet by a free vascularised osteochondral autograft: anatomic study and report of a patient. J Hand Surg 30A:1200.e1–1200.e14

    Google Scholar 

  8. Freedman DM, Botte MH, Gelberman RH (2001) Vascularity of the carpus. Clin Orthop 383:47–59

    Article  PubMed  Google Scholar 

  9. Gellman H, Botte MJ, Shankwiler J et al (2001) Arterial patterns of the deep and superficial palmar arches. Clin Orthop 383:41–46

    Article  PubMed  Google Scholar 

  10. Gomoll AH, Madry H, Kuntsen G et al (2010) The subchondral bone in articular cartilage repair: current problems in the surgical management. Knee Surg Sports Traumatol Arthrosc 18:434–447

    Article  PubMed  Google Scholar 

  11. Harman BD, Weeden SH, Lichota DK et al (2006) Osteochrondral autograft transplantation in the porcine knee. Am J Sports Med 34:913–918

    Article  PubMed  Google Scholar 

  12. Hastings H, Capo J, Steinberg B et al (1999) Hemicondylar hamate replacement arthroplasty for proximal interphalangeal joint fracture/dislocations (abstr). Presented at the 54th annual meeting of the American Society for Surgery of the Hand, Boston

  13. Hattori Y, Doi K, Takka S et al (2004) Free vascularized joint transfer from the nonreplantable digit as a free flap for primary reconstruction of complex hand injury. J Hand Surg 29A:931–935

    Google Scholar 

  14. Hattori Y, Doi K, Ikeda K et al (2007) Free vascularised proximal interphalangeal joint transfer from a damaged finger as a secondary procedure. J Hand Surg 35E:594–595

    Google Scholar 

  15. Hierner R, Berger AK (2007) Long-term results after vascularised joint transfer for finger joint reconstruction. Br J Plast Surg 61:1338–1346

    Google Scholar 

  16. Ishida O, Ikuta Y, Kuroki H (1994) Ipsilateral osteochondral grafting for finger joint repair. J Hand Surg Am 19(3):372–377

    Article  PubMed  CAS  Google Scholar 

  17. Kiefhaber TR (2011) Trials and tribuations in the management of proximal interphalangeal joint injuries. 66th annual meeting of the American society for surgery of the hand. Available via DIALOG. http://www.assh.org/AnnualMeeting/AnnualMeetingArchives/SYMP11_MEET11.pdf. Accessed 17 Sep 2012

  18. Kleemann RU, Schell H, Thompson M et al (2007) Mechanical behaviour of articular cartilage after osteochondral autograft transfer in an ovine model. Am J Sports Med 35:555–563

    Article  PubMed  Google Scholar 

  19. Korambayil PM, Francis A (2011) Hemi-hamate arthroplasty for pilon fractures of finger. Indian J Plas Surg 44:458–466

    Article  Google Scholar 

  20. McAuliffe JA (2009) Hemi-hamate autograft for the treatment of unstable dorsal fracture dislocation of the proximal interphalangeal joint. J Hand Surg 34A:1890–1894

    Google Scholar 

  21. Mestdagh H, Bailleul JP, Chambon JP, Laraki A (1979) The dorsal arterial network of the wrist with reference to the blood supply of the carpal bones. Acta Morphol Neerl Scand 17(1):73–80

    PubMed  CAS  Google Scholar 

  22. Mestdagh H (1980) Anatomy of the arcus volaris profundus of man (author’s transl). Anat Anz 147(2):180–187

    PubMed  CAS  Google Scholar 

  23. Ozyurekoglu T (2010) Multiple osteochondral autograft transfer to the proximal interphalangeal joint: case report. J Hand Surg 35A:931–935

    Google Scholar 

  24. Panagis JS, Gelberman RH, Taleisnik J et al (1983) The arterial anatomy of the human carpus. Part II: the intraosseous vascularity. J Hand Surg 8A:375–382

    Google Scholar 

  25. Redman SN, Oldfield SF, Archer CW (2005) Current strategies for articular cartilage repair. Eur J Cell Mater 9:23–32

    CAS  Google Scholar 

  26. Rezende MR, Mattar R, Cho AB et al (2004) Anatomic study of the dorsal arterial system of the hand. Rev Hosp Clin Fac Med Sao Paulo 59:71–76

    Article  PubMed  Google Scholar 

  27. Tagil M, Astrand J, Westman L, Aspenberg P (2004) Alendronate prevents collapse in mechanically loaded osteochondral grafts: a bone chamber study in rats. Acta Orthop Scand 75:756–761

    Article  PubMed  Google Scholar 

  28. Tagil M, Aspenberg P, Astrand J (2006) Systemic zoledronate precoating of a bone graft reduces bone resorption during remodelling. Acta Orthop 77:23–26

    Article  PubMed  Google Scholar 

  29. Tibesku CO, Szuwart T, Kleffner TO et al (2004) Hyaline cartilage degenerates after autologous osteochondral transplantation. J Orthop Res 22:1210–1214

    Article  PubMed  CAS  Google Scholar 

  30. Williams RM, Kiefhaber TR, Sommerkamp TG et al (2002) Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg 28A:856–865

    Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, The Northern Hospital, 185 Cooper St, Epping, VIC, 3076, Australia

    Warren M. Rozen, Vachara Niumsawatt & Edmund W. Ek

  2. Department of Surgery, Faculty of Medicine, Monash University, Clayton, VIC, 3168, Australia

    Warren M. Rozen, Vachara Niumsawatt, Richard Ross, James C. Leong & Edmund W. Ek

Authors
  1. Warren M. Rozen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vachara Niumsawatt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James C. Leong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Edmund W. Ek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Warren M. Rozen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rozen, W.M., Niumsawatt, V., Ross, R. et al. The vascular basis of the hemi-hamate osteochondral free flap. Part 1: vascular anatomy and clinical correlation. Surg Radiol Anat 35, 585–594 (2013). https://doi.org/10.1007/s00276-013-1098-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-013-1098-0

Keywords

Search

Navigation