Article
Preservation of metacarpophalangeal joint function in traumatic defects by metatarsophalangeal osteochondral transplantation
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Authors
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Steffen Löw
- Praxis für Handchirurgie und Unfallchirurgie, Bad Mergentheim, Germany
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Marion Papay
- Caritas-Krankenhaus, Klinik für Orthopädie und Unfallchirurgie, Bad Mergentheim, Germany
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Christoph Eingartner
- Caritas-Krankenhaus Bad Mergentheim, Klinik für Orthopädie und Unfallchirurgie, Bad Mergentheim, Germany
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: The integrity of the metacarpophalangeal (MCP) joints is essential for finger and hand function. Preservation of range of motion is one of the aims in reconstruction of complex injuries to these joints. Avascular transplants of whole joints are prone to resorption and deterioration of function, whereas osteochondral transplants have shown to be reliable in reconstruction of various joint defects. This series presents three patients with traumatic injuries to four MCP joints, which were reconstructed by seven avascular osteochondral transplants of metatarsophalangeal (MTP) joints. The joints were examined for radiographic signs of resorption or joint space narrowing, and if this would affect the joints' function.
Methods: Between 09/2009 and 01/2015, in three patients (age of 40, 45 and 48 years) with complex injuries to their MCP joints (one milling, two saw injuries), four joints were reconstructed by seven osteochondral transplants of their toe MTP joints. Thereby, three metatarsal head and four osteochondral transplants of the base of the proximal toe phalanges were used. Beside the joint itself, various soft tissue defects were to be reconstructed in each patient. The patients were clinically and radiographically examined after 3, 6, respectively 9 years.
Results and Conclusions: None of the patients complained of pain, neither in the involved joint of the reconstructed finger, nor at their toes. All patients were satisfied with the result of reconstruction. DASH score was 13, 29, and 24, respectively. Range of motion in the four affected joints were 25, 60, 75, respectively 90°. Radiographic examination revealed moderate joint space narrowing in one of the four joints. In another patient, localized osteolysis was found around the screws heads, so that the screws were removed seven years post-op.
Osteochondral transplants for reconstruction of MCP defects are able to preserve function in severely injured joints in the mid and long-term. Joint space narrowing may occur, but this does not cause pain. Since localized osteolysis can cause screw head prominence, midterm radiographic follow-up is necessary to prevent further damage to the joint. In the long-term, remaining bone stock may be adequate for total joint replacement.
