Emergency metacarpophalangeal arthroplasty with bone grafting for traumatic joint destruction

Arthroplasty for Treating Traumatic Metacarpophalangeal Joint Defects: A Retrospective Study Over Three Years

Background

Bone loss at the metacarpophalangeal joint (MCP) after trauma is difficult to treat.

Objective

We aimed to investigate the effectiveness of Swanson's arthroplasty and the reason for implant fracture.

Methods

We retrospectively analyzed the data of 175 patients who underwent emergency MCP arthroplasty between 2013 and 2016. Some patients used a orthosis to limit the radioulnar movement of the metacarpal joint for eight weeks after surgery (Group A), while the other patients underwent only hand rehabilitation after surgery (Group B). The basic information and perioperative data of the patients were compared. The patients were followed up clinically for an average of 65±19 months. Postoperative and follow-up complications and functional parameters were recorded and compared. Stress model of implant fracture had been analyzed in order to mark the frequent area.

Results

A total of 162 patients were followed up, 4 of whom were lost to follow-up completely and 9 of whom were followed up by telephone only. There were 11 and 26 implant fractures in groups A and B, respectively (P=0.019), and the degrees of radioulnar movement were 2±1° and 7±4°, respectively (P<0.01). The disabilities of the arm, shoulder, and hand (DASH) score and MCP joint range of motion (ROM) did not significantly differ.

Conclusion

The effect of Swanson’s arthroplasty for bone loss at MCP joint is useful. The radioulnar stress may be the reason for implant fracture. Joint orthosis can reduce the incidence of implant fractures.

Emergency metacarpophalangeal arthroplasty with bone grafting for traumatic joint destruction: a report on two cases

Traumatic destruction of the metacarpophalangeal joints with bone defect is a technical challenge for surgeons when maintaining joint mobility is a priority for the patient. An emergency metacarpophalangeal arthroplasty with bone graft has been described in the literature for dorsal defects in the proximal phalanx. We have adapted this technique to allow us to perform this arthroplasty with bone graft in all defects of the proximal phalanx.

Chondrocostal grafting for lateral osteochondral injury of the metacarpal head

Osteochondral injuries of the metacarpal head require anatomical restoration to prevent limitations in range of motion and osteoarthritis. Osteochondral bone grafting is a viable option, especially in younger patients. Central injuries allow for different types of grafting, but when the injured area is on the lateral portion of the metacarpal head, the graft must include both a cortical and a cartilaginous portion. We present here the pearls and pitfalls in the surgical technique of chondrocostal grating from the 6th rib and an example of its use within a case of comminuted fracture of the metacarpal head. This technique provides a graft with cortical bone that allows for a stable fixation, with few complications during its harvesting. The graft is viable in the long-term and shows similar magnetic resonance intensities in comparison to hand cartilage.