This 52 year old male sustained a circular saw injury to his left index finger.
This image shows the injury over the PIPJ on the dorsum.
Describe and Explain the injury
This is a mutilating injury of the PIPJ showing a osteochondral loss of the proximal phalangeal head.
The swage of the saw will result in the loss of tissue depending on the thickness of the saw blade.
Here there is a complete loss os bone skin and cartilage the thickness of the saw blade.
If more than 50% of the articular surface is involved it will require a osteochondral graft to bridge the defect.
Here the PIPJ has been reduced and the Central slip being reattached with a Mitec anchor.
Post repair
Keep K wires for 6 weeks and remove and start with Capner splint mobilisation
The defect will be filled with fibrocartilage
Ref:
J Hand Surg Am. 2010 Apr;35(4):604-10.
Morphometric analysis of potential osteochondral autografts for resurfacing unicondylar defects of the proximal phalanx in PIP joint injuries.
Hernandez JD, Sommerkamp TG.
Hand and Wrist Center at Coordinated Health, Bethlehem, PA 18020, USA. jondhernandez@yahoo.com
Abstract
PURPOSE: This study was designed to morphometrically assess the base of the little and ring finger metacarpals as potential osteochondral donors to resurface distal condylar defects of the proximal phalanx. METHODS: The proximal phalanges were dissected from all 4 fingers in 10 cadaveric hands and the following measurements were obtained from the distal condylar surface: anteroposterior height, radial-ulnar width, and radius of curvature. Measurements were obtained from posteroanterior and lateral radiographic views, which were digitized and analyzed using digital imaging software. Comparable measurements were obtained from the base of the small and ring metacarpals. RESULTS: The anteroposterior dimension of both potential donor metacarpals was large enough to resurface the distal condyles of each of the proximal phalanges; however, this was not true for the radial-ulnar dimensions. The distal ulnar condyle of the long finger proximal phalanx was largest, measuring 4.9 (+/- 0.) mm dorsally and 6.2 (+/- 0.5) mm volarly in the radial-ulnar dimension. Only the small metacarpal base had sufficient stock in the radial-ulnar dimension (9.4 [+/- 1.7]) mm dorsally and 10.6 [+/- 2.0] mm volarly) to resurface this condyle. With respect to radius of curvature (ROC), the donor-to-recipient ROC ratio was 1.43 for the small metacarpal base versus 2.12 for the ring metacarpal base. Linear regression analysis revealed a stronger relationship in ROC between donor and recipient condyle when the small metacarpal base served as the donor (R = 0.96 vs R = 0.60). CONCLUSIONS: As determined from morphometric measurements of the 2 potential donor sites tested, the base of the small metacarpal provides the best match for resurfacing distal condylar defects of the proximal phalanges.
J Hand Surg Am. 1994 May;19(3):372-7.
Ipsilateral osteochondral grafting for finger joint repair.
Ishida O, Ikuta Y, Kuroki H.
Department of Orthopaedic Surgery, Hiroshima University School of Medicine, Japan.
Abstract
A method for reconstructing articular osteochondral defects of the joint surfaces of the fingers is described. An osteochondral graft was harvested from the distal or proximal side of the second or third carpometacarpal joint of the ipsilateral hand. The graft was subsequently transplanted to the site of the defect in the proximal or distal interphalangeal joint. Ten cases with a follow-up period of more than 2 years were reviewed. The mean angular deformity decreased from 33 degrees to 4 degrees, and the mean active range of motion increased from 22 degrees to 38 degrees. Plain x-ray films revealed good joint congruity, and no donor site morbidity was appreciated. This treatment approach may be particularly useful in children.
|
Welcome to the Hand Surgery Manual. This is an educational resource for the international hand surgical community. This website provides a unique source of lecture material, videos, podcasts as well as up to date research in the field of hand surgery.
