gms | German Medical Science

Objectives/Interrogation: Show innovative surgical technique for the reconstruction of dysfunctional joints of the hand. A viable option is presented to reestablish the interphalangeal joint function. Will this technique be a good option?

Methods: We present two cases of patients with loss of interphalangeal joint functionality of the hand,secondary a circular saw. Non-vascularized joint transfer from functional metacarpo-phalangeal to dysfunctional interfalangia is performed to re-establish joint function. First case 62-year-old man. It has amputation at F1 level in the 5th finger and arthrodesis of proximal PIP of second finger. A non-vascularized transfer of the 5thmetacarpophalangeal joint to the proximalinterphalangeal joint of the index finger was performed. Joint resection of MTF and PIP joint,edges regularization, MTF joint placement replacing the PIP in index, fixation with minifragment screws without head, through articular cartilage. Repair in second surgery of flexor tendons. Second patient, male, 34 years old. Trauma with amputation at the index finger F1 level, dysfunctional PIP of third finger of the same hand. Resection is performed devacularized MTF block of the index finger, transferred to PIP of third finger. The technique was modified, cortical-spongy bone wedge construction with articular cartilage was made, both wedges are adapted to F1 and F2 bones, achieving adaptation with non osteosynthesis material.

Results and Conclusions: The first case, articular cartilage necrosis was generated, so the osteosynthesis material had to be removed. Patient can still perform work, with limited mobility of PIP transfer. No pain and partial functionality. The second case do not generate articular cartilage necrosis. We think that it was secondary because we did not place osteosynthesis and bone wedge was left for osseointegration. Joint transfer is a viable option in patients suffering from interdigital joint dysfunction. The context of the patient, the donor joint, the receiving joint, the receiving site where the transfer is made, the state of the soft tissues and also explain the patient that it has a failure rate, series describe up to 15% must be taken into account. The greater follow-up is necessary, as well as increasing the number of patients who perform this type of surgeries. In our center, with low resources, in a context where agriculture is the main work, the functionality of the hand is essential. This is why it is a viable option to re-establish joint functionality.