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Is a Vascularized Interphalangeal Unicondylar Transfer Worth the Efforts? Surgical Technique and Clinical Application. Indian J Orthop 2022; 56:1464-1468. [PMID: 35928666 PMCID: PMC9283594 DOI: 10.1007/s43465-022-00664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023]
Abstract
Interphalangeal joints (IPJ) play a key role in hand function for performing activities of daily living and are frequently involved in complicated injuries resulting in significant functional limitations such as secondary arthritis and stiffness being the most challenging. In adult patients with more than 5 mm bone loss of the proximal articular surface who request a functional interphalangeal joint with minimal pain a vascularized joint transfer is a treatment choice. A unicondylar loss more than 5 mm wide in a 22-year-old carpenter is reported and illustrates our experience with a vascularized unicondylar transfer showing the advantages compared to the "classic" total joint transfer or distal interphalangeal (DIP) joint arthrodesis. By using this technique at the 12-month follow-up, we achieved no donor site complications, a good graft alignment, a good joint congruity, complete bone healing and a normal vascular patency with no signs of bone malunion or resorption of the graft.
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Alnaimat FA, Owida HA, Al Sharah A, Alhaj M, Hassan M. Silicone and Pyrocarbon Artificial Finger Joints. Appl Bionics Biomech 2021; 2021:5534796. [PMID: 34188692 PMCID: PMC8195645 DOI: 10.1155/2021/5534796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 12/04/2022] Open
Abstract
Artificial finger joint design has been developed through different stages through the past. PIP (proximal interphalangeal) and MCP (metacarpophalangeal) artificial finger joints have come to replace the amputation and arthrodesis options; although, these artificial joints are still facing challenges related to reactive tissues, reduced range of motion, and flexion and extension deficits. Swanson silicone artificial finger joints are still common due to the physician's preferability of silicone with the dorsal approach during operation. Nevertheless, other artificial finger joints such as the pyrocarbon implant arthroplasty have also drawn the interests of practitioners. Artificial finger joint has been classified under three major categories which are constrained, unconstrained, and linked design. There are also challenges such as concerns of infections and articular cartilage necrosis associated with attempted retention of vascularity. In addition, one of the main challenges facing the silicone artificial finger joints is the fracture occurring at the distal stem with the hinge. The aim of this paper is to review the different artificial finger joints in one paper as there are few old review papers about them. Further studies need to be done to develop the design and materials of the pyrocarbon and silicone implants to increase the range of motion associated with them and the fatigue life of the silicone implants.
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Affiliation(s)
- F. A. Alnaimat
- Medical Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
| | - H. A. Owida
- Medical Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
| | - A. Al Sharah
- Computer Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
| | - M. Alhaj
- Computer Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
| | - Mohammad Hassan
- Civil Engineering, Faculty of Engineering, Al-Ahliyya Amman University, Al-Saro, Al-Salt, Amman, Jordan
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Abstract
Background Proximal row carpectomy (PRC) is a useful treatment option for wrist arthritis, but the operation is contraindicated when there is arthritis of the capitate head. We describe a technique that involves resurfacing of a capitate that has focal chondrosis, using an osteochondral graft harvested from the resected carpal bones. Materials and Methods PRC patients who had a focal area of capitate chondrosis underwent osteochondral grafting of the capitate. Pre- and postoperative pain level, employment status, motion, grip strength, and Modified Mayo Wrist Scores (MMWS) were assessed. Postoperative Disability of the Arm, Shoulder, and Hand (DASH) scores were also calculated. Description of Technique The articular surface of the capitate is assessed for need for grafting. The proximal row is resected with the lunate removed intact. The arthritic area is prepared. The graft is taken from the lunate and placed in the prepared site of the capitate. Results Eight patients (average age of 53 years) were followed for 18 months. Pain: Preoperatively, moderate to severe in 7 patients; postoperatively, mild to no pain in 7 patients. Motion: Preoperative, 84° (74% of the contralateral side); postoperative 75° (66%). Grip Strength: Preoperative, 29 kg (62%); postoperative, 34 kg (71%). Mayo Wrist Score: Preoperative, 51 (poor); postoperative, 68 (fair). Average postoperative DASH score was 19.5. Follow-up radiographs showed that 75% of patients had mild to no degeneration. Conclusions Osteochondral grafting in PRC offers satisfactory results in terms of pain relief, return to work, motion, and grip strength. Level of Evidence Therapeutic IV, Case series.
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Affiliation(s)
- Peter Tang
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Joseph E. Imbriglia
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Western Pennsylvania Hand and UpperEx Center, Wexford, Pennsylvania
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Ng CY, Watts AC. The use of non-vascularised osteochondral autograft for reconstruction of articular surfaces in the hand and wrist. ACTA ACUST UNITED AC 2013; 94:1448-54. [PMID: 23109620 DOI: 10.1302/0301-620x.94b11.30082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bone loss involving articular surface is a challenging problem faced by the orthopaedic surgeon. In the hand and wrist, there are articular defects that are amenable to autograft reconstruction when primary fixation is not possible. In this article, the surgical techniques and clinical outcomes of articular reconstructions in the hand and wrist using non-vascularised osteochondral autografts are reviewed.
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Affiliation(s)
- C Y Ng
- Upper Limb Unit, Wrightington Hospital, Hall Lane, Appley Bridge, Wigan WN6 9EP, UK.
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Han KJ, Oh KS, Chung NS, Lee YS, Youn S. Radial head arthroplasty using a metatarsal osteochondral autograft. INTERNATIONAL ORTHOPAEDICS 2012; 36:2501-6. [PMID: 23052277 DOI: 10.1007/s00264-012-1666-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 09/12/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Treatment of comminuted fractures of the radial head is controversial, and considerable effort has been made to restore optimal function of the elbows, either by surgical reconstruction or prosthetic replacement. This report presents our experiences in treatment of unreconstructable radial head or neck fractures using osteochondral autografts harvested from the base of the second metatarsal bones. METHODS Five patients with radial head and one with a radial neck fracture underwent treatment with osteochondral autografts. After excision of the unreconstructable radial head, the second metatarsal base was harvested and transplanted to the radius using the intramedullary nailing technique. RESULTS The reconstructed elbows were examined clinically and radiographically for a mean period of 44.8 months (range, 24-72 months). At the last follow-up, in flexion-extension, the mean elbow mobility was 130°/10°. In supination-pronation, the mean elbow mobility was 73.3°/66.7°, with a mean loss of supination of 19.2° and loss of pronation of 12.5°. Grip strength was 91%, compared with the contralateral limb. The mean Mayo Elbow Performance Score was 94.2. The mean score of AOFAS rating system to the lesser toe was 93.7 points. CONCLUSION Radial head arthroplasty with an osteochondral autograft from the second metatarsal base appears to be an effective alternative for treatment of unreconstructable radial head fractures. A larger group of patients and a longer follow-up period will be required in order to ease concerns regarding the donor site; however, none of the patients who underwent this procedure showed any complications during follow-up.
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Affiliation(s)
- Kyeong-Jin Han
- Department of Orthopaedic Surgery, Ajou University School of Medicine, Paldal-gu, Suwon City, South Korea
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The use of a third metacarpal base osteoarticular flap for treatment of metacarpophalangeal joint traumatic defects. J Hand Surg Am 2012; 37:1791-805. [PMID: 22854255 DOI: 10.1016/j.jhsa.2012.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 06/01/2012] [Accepted: 06/04/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the use of a pedicled osteoarticular flap harvested from the base of the third metacarpal for the treatment of traumatic defects of the metacarpophalangeal (MCP) joints. METHODS From February 2006 to January 2008, we included in the study 15 patients with posttraumatic defects of the MCP joints. The mean age of the patients was 35 years. The injured MCP joints were located in the thumb (n = 6) and index (n = 4), middle (n = 4), and ring fingers (n = 1). Of the 15 patients, 10 presented with acute injuries and 5 with old injuries. At follow-up, we assessed active motion and pinch strength and compared all measurements with those from the opposite hand. In patients with old MCP joint injuries, we also compared preoperative and postoperative motion and pinch strength. We assessed hand function using the Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS At the final follow-up (mean, 28 mo), the mean motion arc of the reconstructed MCP joints and the opposite joints was 46° and 91°, respectively, and the mean pinch strength of the injured and opposite sides was 5.4 and 7.1 kg, respectively. For the 5 patients with old injuries to the fingers, the mean preoperative and postoperative motion arc was 2° and 43°, and the mean preoperative and postoperative pinch strength was 1.6 and 5.3 kg, respectively. The mean Disabilities of the Arm, Shoulder, and Hand score of the entire patient series was 9, whereas the mean preoperative and postoperative scores of the 5 patients with old injuries were 44 and 17, respectively. CONCLUSIONS The use of a pedicled osteoarticular flap harvested from the base of the third metacarpal is a reliable technique for the treatment of traumatic defects of the MCP joints.
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Comparison of third toe joint cartilage thickness to that of the finger proximal interphalangeal (PIP) joint to determine suitability for transplantation in PIP joint reconstruction. J Hand Surg Am 2011; 36:1950-8. [PMID: 22051232 DOI: 10.1016/j.jhsa.2011.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 09/15/2011] [Accepted: 09/16/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the cartilage thickness of the third toe joints to the finger proximal interphalangeal (PIP) joints to assess the appropriateness of using third toe osteochondral grafts for finger PIP joint reconstruction. METHODS A laser scanner was used to construct 3-dimensional computer models of 6 matched cadaver right third toe PIP joints, condyles of the third toe middle phalanx, and finger PIP joints with and without cartilage. Cartilage distribution patterns were computed and analyzed for each surface. The cartilage thickness of both sides of the third toe PIP joint and the third toe middle phalanx condyles were compared to the PIP joint of the fingers. A total of 18 third toe and 48 finger joint surfaces were analyzed. RESULTS For the third toe middle phalanx condyles, the mean thickness was 0.20 ± 0.09 mm with a maximum of 0.52 ± 0.18 mm, and a coefficient of variation (CV%; a measure of uniformity of cartilage distribution) of 62. For the third toe proximal phalanx condyles, the mean cartilage thickness was 0.26 ± 0.10 mm with a maximum thickness of 0.56 ± 0.14 mm and a CV% of 44. The mean thickness, maximum thickness, and CV% of the finger proximal phalanx condyles was 0.43 ± 0.11 mm, 0.79 ± 0.16 mm, and 31, respectively. For the third toe middle phalanx base, the mean thickness was 0.28 ± 0.06 mm with a maximum of 0.47 ± 0.09 mm and a CV% of 34, compared to the finger middle phalanx base mean of 0.40 ± 0.12 mm with a maximum of 0.67 ± 0.14 mm and a CV% of 27. CONCLUSIONS There were significant differences in cartilage thickness between the third toe and the fingers in this study. However, fewer differences were observed with the third toe middle phalanx base cartilage thickness than with the third toe condyles in comparison to the fingers.
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Hendry JM, Mainprize J, McMillan C, Binhammer P. Structural comparison of the finger proximal interphalangeal joint surfaces and those of the third toe: suitability for joint reconstruction. J Hand Surg Am 2011; 36:1022-7. [PMID: 21511403 DOI: 10.1016/j.jhsa.2011.01.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 01/28/2011] [Accepted: 01/28/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE This study compared the degree of surface structural similarity between finger proximal interphalangeal joints and third toe articular surfaces to assess the appropriateness of using partial toe articular osteochondral grafts for finger joint reconstruction. METHODS Computer models were generated from 4 paired cadaver hands and feet and compared the radius of curvature of toe and finger articular surfaces. The angle created by the palmar divergence of adjacent condyles of the same phalanx was also compared and described as the angular difference. The distal articular surfaces of the third toe proximal and middle phalanx were compared to distal articular surfaces of all 4 finger proximal phalanges. The radius of curvature was also compared between the third toe middle phalanx base and those of all 4 fingers. RESULTS The toe middle phalanx medial and lateral condyles were 66% and 60% the size of the respective finger condyles. The mean angular difference between adjacent condyles of the toe middle phalanx compared to the finger was 20°. The toe proximal phalanx medial and lateral condyles were 75% and 70% the size of the respective finger condyles, with a mean angular difference between adjacent condyles of 6°. The toe middle phalanx medial base was closer in size to that of the finger (95% to 178%) compared to the toe middle phalanx lateral base (205% to 254%). CONCLUSIONS This study revealed that the third toe proximal phalanx distal articular surface more closely matched the geometric characteristics of the finger proximal phalanx distal articular surface than did the toe middle phalanx distal articular surface. The medial base of the toe middle phalanx more closely approximated the size of the finger middle phalanx base than did the lateral toe middle phalanx base. CLINICAL RELEVANCE Quantitative data have been provided to help guide third toe osteochondral donor site selection when reconstructing traumatic finger proximal interphalangeal joint defects. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- James Michael Hendry
- Division of Plastic Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Posterior Capitellum Impaction Fracture Associated With Posterolateral Instability of the Elbow. TECHNIQUES IN SHOULDER AND ELBOW SURGERY 2008. [DOI: 10.1097/bte.0b013e318182aaab] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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del Piñal F, García-Bernal F, Delgado J, Sanmartín M, Regalado J, Igual Pérez B. Injerto osteocondral vascularizado de la base del tercer metatarsiano para los callos viciosos intraarticulares del extremo distal del radio. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1888-4415(08)74815-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Two-stage arthroplasty with joint distraction and costal osteochondral grafting for ankylosis of a metacarpophalangeal joint: Nine years' follow-up. J Plast Reconstr Aesthet Surg 2008; 61:e1-4. [DOI: 10.1016/j.bjps.2008.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 01/22/2008] [Accepted: 03/14/2008] [Indexed: 11/18/2022]
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del Piñal F, García-Bernal F, Delgado J, Sanmartín M, Regalado J, Igual Pérez B. Use of a vascularized osteochondral graft from the base of the third metastarsal to address intraarticular malunions of the distal radius. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Tang P, Imbriglia JE. Osteochondral resurfacing (OCRPRC) for capitate chondrosis in proximal row carpectomy. J Hand Surg Am 2007; 32:1334-42. [PMID: 17996766 DOI: 10.1016/j.jhsa.2007.07.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 07/14/2007] [Accepted: 07/17/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE Proximal row carpectomy (PRC) can be an effective treatment option for arthritis of the wrist, but the operation is contraindicated when there is substantial arthritis of the capitate head. We describe a new technique that involves resurfacing of the capitate when there is chondrosis by using osteochondral grafts harvested from the resected carpal bones. The purpose of this study was to assess the outcomes of patients who had osteochondral resurfacing in the setting of PRC (OCRPRC) for capitate chondrosis and to determine how they compare with published results of conventional PRC. METHODS Patients having PRC who had grade II to IV (Modified Outerbridge Scale) capitate chondrosis underwent osteochondral resurfacing of the capitate. Preoperative and postoperative pain level, employment status, range of motion (ROM), grip strength, and Mayo wrist scores were assessed, and Student's t-test was used. Postoperative Disability of the Arm, Shoulder and Hand (DASH) scores were also calculated. RESULTS Eight patients with an average age of 53 years were followed up for 18 months. Preoperatively, 7 patients described their pain as moderate to severe; postoperatively, 7 patients described their pain as mild to no pain. Preoperative arc of motion was 84 degrees (74% of the contralateral side); postoperative arc of motion was 75 degrees (66% of the contralateral side). Preoperative grip strength was 29 kg, or 62% of the contralateral side; postoperative grip strength was 34 kg, or 71% of the contralateral side. Preoperative Mayo wrist score was 51 ("poor"); postoperative Mayo wrist score was 68 ("fair"). Average postoperative DASH score was 19.5. Follow-up radiographs showed that 75% of patients had mild to no degeneration. Magnetic resonance imaging at 21 months postoperatively showed graft incorporation. No complications were encountered. CONCLUSIONS Our results with osteochondral resurfacing compare favorably with the published results of conventional PRC in terms of pain relief, employment status, ROM, and grip strength.
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Affiliation(s)
- Peter Tang
- College of Physicians & Surgeons, Columbia University, New York, NY 10032, USA.
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del Piñal F, Innocenti M. Evolving concepts in the management of the bone gap in the upper limb. Long and small defects. J Plast Reconstr Aesthet Surg 2007; 60:776-92. [PMID: 17452133 DOI: 10.1016/j.bjps.2007.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 03/07/2007] [Indexed: 11/18/2022]
Abstract
Vascularised bone graft is a well accepted technique when dealing with long defects. Its role in refractory nonunion, in small defects and in the growing patient is rarely discussed. In this paper the authors review the different alternatives to deal with bone defects in the upper extremity. The indications of vascularised corticoperiosteal graft for solving small defects harbouring refractory nonunion, and the use of vascularised bone phalanx and metatarsal for complex - but small - defects in the fingers is presented. The ability of the bone to grow and remodel when a living epiphysis is included, and to maintain the cartilage viability when a composite osteochondral graft is transferred are also discussed.
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Affiliation(s)
- Francisco del Piñal
- Unit of Hand-Wrist and Plastic Surgery, Hospital Mutua Montañesa, Instituto de Cirugía Plástica y de la Mano, Santander, Spain.
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Del Piñal F, García-Bernal FJ, Delgado J, Sanmartín M, Regalado J. Reconstruction of the distal radius facet by a free vascularized osteochondral autograft: anatomic study and report of a patient. J Hand Surg Am 2005; 30:1200-10. [PMID: 16344177 DOI: 10.1016/j.jhsa.2005.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 07/06/2005] [Accepted: 07/06/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE Large chondral defects of the distal radius after fractures present a reconstructive challenge. The purpose of this study was to present the anatomic findings from a cadaver of a vascularized osteochondral autograft taken from the third metatarsal appropriate for reconstructing the distal radius articular facet. A patient is presented in whom 70% of the scaphoid fossa was reconstructed with this technique. METHODS The base of the third metatarsal was studied in the feet of 20 cadavers. The size and shape of the cartilage were measured. Additionally vessel distribution was recorded and the diameters of vascular foramina were measured with Juch's method. RESULTS The base of the third metatarsal is pear shaped and is wider dorsally than plantarly. It averages 19.2 mm long on its main axis. Its cartilaginous surface is minimally concave or flat and it is slanted slightly proximal-dorsal to distal-plantar and proximal-peroneal to distal-tibial. Nutrient foramina were found in every case in the dorsum and on both sides of the proximal shaft. At least 1 nutrient vessel could be tracked back to the dorsalis pedis in every dissected specimen. CONCLUSIONS The anatomic features of the base of the third metatarsal make it a potential vascularized autograft to consider for osteochondral defects of the distal radius.
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Affiliation(s)
- Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Hospital Mutua Montañesa and Clínica Mompía, Santander, Spain.
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Williams RMM, Kiefhaber TR, Sommerkamp TG, Stern PJ. Treatment of unstable dorsal proximal interphalangeal fracture/dislocations using a hemi-hamate autograft. J Hand Surg Am 2003; 28:856-65. [PMID: 14507519 DOI: 10.1016/s0363-5023(03)00304-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE This retrospective study was designed to evaluate the clinical and radiographic results of a hemi-hamate autograft for the treatment of comminuted dorsal proximal interphalangeal (PIP) joint fracture/dislocations. METHODS Thirteen consecutive patients underwent hemi-hamate autograft for the treatment of an unstable dorsal PIP fracture dislocation. The fractured middle phalangeal base was debrided and the defect was replaced using a size-matched portion of the dorsal/distal hamate osteoarticular surface and was secured with miniscrews. The average middle phalangeal volar lip involvement on initial radiographs was 60% (range, 40% to 80%). The average time to surgery was 45 days (range, 2-175 d). Range of motion, stability, and grip strength were measured at a mean follow-up evaluation of 16 months. Radiographs were evaluated for union, graft incorporation, and/or collapse. Subjective data, satisfaction, and return to work were obtained on 12 of the 13 patients at a mean follow-up evaluation of 17 months. RESULTS The average arc of motion at the PIP joint was 85 degrees (range, 65 degrees to 100 degrees ). The distal interphalangeal (DIP) joint average arc of motion was 60 degrees (range, 35 degrees to 80 degrees ). Average grip strength was 80% of the uninjured side. Bony union was achieved in all patients. One graft showed ulnar collapse but graft resorption was not noted. Except for 2 patients with recurrent dorsal subluxation there were no complications. The average pain level was 1.3 (as rated on a visual analog scale of 0-10). Eleven of 12 patients were very satisfied with their function and one was somewhat satisfied; one patient was lost to follow-up. CONCLUSIONS When greater than 50% of the volar base of the middle phalanx is fractured in a PIP fracture/dislocation or the joint remains unstable despite a lesser degree of involvement, a hemi-hamate autograft should be considered. This procedure reconstructs the cup-shaped contour of the middle phalangeal articular surface and facilitates a stable, functional arc of motion at the PIP joint. Additionally, in our experience the procedure renders minimal disability and has a low complication rate.
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Affiliation(s)
- Rafael M M Williams
- Department of Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0212, USA
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Weinzweig J, Pantaloni M, Spangenberger A, Marler J, Zienowicz RJ. Osteochondral reconstruction of a non-weight-bearing joint using a high-density porous polyethylene implant. Plast Reconstr Surg 2000; 106:1547-54. [PMID: 11129184 DOI: 10.1097/00006534-200012000-00016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Currently, there is no reliable reconstructive modality allowing anatomic resurfacing of traumatic digital osteochondral articular defects. The purpose of the present study is to demonstrate the utility of Medpor, a high-density porous polyethylene (HDPP) scaffold biomaterial that can (1) be readily contoured to fit any joint defect, (2) permit stable internal fixation, and (3) permit osteocyte and chondrocyte ingrowth and subsequent articular cartilage resurfacing necessary to restore joint congruity. HDPP has gained wide acceptance for use in craniofacial and skeletal reconstruction and augmentation. An avian non-weight-bearing joint model was designed to study the role of the HDPP implant in small joint reconstruction. An osteochondral defect was created with a 5-mm circular punch in the humeral articular surface of both glenohumeral joints of 32 adult White Leghorn chickens. In each animal, one defect was press-fitted with a correspondingly sized HDPP implant (HDPP implant group); the contralateral defect was filled with the original osteochondral plug (isograft group) or left unrepaired (control group). At 2 weeks, and 1, 3, and 6 months,joints from each group were harvested and evaluated. Over the 6-month study period, joints in the control group demonstrated healing with dense collagenous scar tissue leaving residual defects at the articular surfaces and significant degenerative disease of the glenohumeral joints radiographically. Joints in the isograft group demonstrated near-complete resorption with some preservation of the cartilaginous cap but overall depression of the articular surface and significant degenerative joint disease. Joints in the HDPP implant group demonstrated stable fixation by highly mineralized bony trabecular ingrowth, preservation of the articular contour of the humeral head, and no evidence of significant degenerative joint disease. These findings indicate a potential role for this high-density porous polyethylene implant in the reconstruction of small joint articular and osseous defects.
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Affiliation(s)
- J Weinzweig
- Department of Plastic Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence 02905, USA
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Gaul JS. Articular fractures of the proximal interphalangeal joint with missing elements: repair with partial toe joint osteochondral autografts. J Hand Surg Am 1999; 24:78-85. [PMID: 10048520 DOI: 10.1053/jhsu.1999.jhsu24a0078] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Five cases of traumatic destruction of a condyle of the proximal interphalangeal joint repaired with a free autogenous graft of a corresponding toe condyle are presented. Precise fitting is essential: 1 patient required a second graft when the initial undersized graft was absorbed. Four of the 5 cases regained laterally stable bicondylar joints and functional fingers. Range of motion varied inversely to the magnitude of the injury and the surgery. Active range of motion at the proximal interphalangeal joint was 80 degrees in 2 digits, 45 degrees in 1, and 10 degrees in 1 complex case; 1 case was considered a failure.
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Affiliation(s)
- J S Gaul
- Department of Orthopedic Surgery, Carolinas Medical Center, Charlotte, NC, USA
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