A Two-Pin Method for Improved Exposure in Shotgun Hemi-Hamate Arthroplasty

Farid Najd Mazhar; Reza Mohammadi; Omid Mahmoudi Nasab; Sajjad Mohammadnabi; Meisam Jafari Kafiabadi; Hooman Shariatzade

doi:10.18502/jost.v11i4.20292

Farid Najd Mazhar Professor, Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Reza Mohammadi Orthopedic Surgeon, Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Omid Mahmoudi Nasab Orthopedic Surgeon, Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Sajjad Mohammadnabi Assistant Professor, Department of Orthopedic Surgery, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
Meisam Jafari Kafiabadi Associate Professor, Department of Orthopedic Surgery, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Hooman Shariatzade Associate Professor, Department of Orthopedics, Bone and Joint Reconstruction Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v11i4.20292

Keywords: Fracture Fixation; Arthroplasty; Hamate Bone; Surgery; Joint Instability

Abstract

This technical note introduces a two-pin technique designed to improve exposure during the shotgun approach for hemi-hamate arthroplasty, a surgical procedure commonly used to treat comminuted intra-articular and chronic proximal interphalangeal (PIP) joint fractures. A 1.0 mm Kirschner wire (K-wire) is inserted into the middle phalanx (P2) distal to the fracture, and a second K-wire is placed into the head of the proximal phalanx (P1). These pins stabilize the joint, facilitate soft tissue retraction, and improve visualization of the fracture site. The graft is harvested from the dorsal distal hamate and shaped to fit the PIP joint before fixation. This method addresses key challenges in visualization and stabilization associated with the shotgun approach. Early feedback suggests improved surgical efficiency, increased accuracy of reduction, and potentially better functional outcomes. The described two-pin technique is simple and reproducible, significantly enhancing exposure and stability during hemi-hamate arthroplasty. Further studies are needed to confirm its long-term effects