Artikel
Free osteochondral graft from ipsilateral hand for treatment of partial finger joint defects in adult
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Autoren
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Hideki Tanaka
- Niigata Prefectural Yoshida Hospital, Department of Orthopaedic Surgery, Tsubame-shi, Niigata, Japan
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: This retrospective study was designed to evaluate clinical results of partial finger joint cartilage defects using osteochondral graft taken from ipsilateral hand in adults.
Methods: Since 1996, 9 fingers of 9 patients were reconstructed by free osteochondral graft. There were 5 men and 4 women with an average age of 42 years (rang, 20 - 68years). The affected joints were 2 MP joints and 4 PIP joints and 3 DIP joints (3 index fingers, 2 long fingers, 3 ring fingers, 1 little finger).
The average cartilage defects was 46% (range, 20 % to 60%). Four joints combined 20% to 50% concomitant cartilage damage facing main lesions.
In 8 patients, surgery was performed at 3 days to 12 years after injuries. In a patient with bone tumor, reconstruction was done at the same time of tumor resection.
Damaged lesions were debrided and prepared for the graft. Osteo-cartilage defects of metacarpal head and proximal phalanx head were replaced by a part of capitate or trapezoid which was close to the shape of original joint surface. In patients with defects of proximal phalanx or middle phalanx base, 2nd or 3rd metacarpus base were adopted as the donor. In a particular case with partial loss of DIP joint, osteo-cartilage graft including a part of ECR tendon was transplanted. The graft was fixed by K-wires.
ROM exercise was started at 4 or 5 weeks after surgery.
The postoperative follow-up period ranged from 6 months to 41 months with a mean of 15 months.
Results and Conclusions: There was neither motion pain nor instability on the recipient. Mean ROM of PIP joints increased from 38 degrees to 53 degrees, and mean ROM of DIP joints increased from 0 degree to 17 degrees. In a patient with traumatic partial loss of DIP joint, it failed to ankylosis 9 months after the surgery.
The grafts were all survived, although shrinkage of grafts were detected in 2, and erosive change in 3.
Six donor sites after harvesting of the graft were filled with autogenous bone graft without morbidity.
The requisite shape of joint defects can be reconstructed using a shape-matched portion of cartilage surface of capitate, trapezoid or base of metacarpus?within the same surgical field.
Although there is limited indication and technical difficulties, but satisfactory functional results can be expected without donor morbidity.
