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Pedicled osteoarticular flap reliable for treatment of metacarpophalangeal joint defects
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For the treatment of traumatic defects of the metacarpophalangeal joints, the use of a pedicled osteoarticular flap harvested from the base of the third metacarpal is a reliable technique, according to this study.
Researchers studied 15 patients with posttraumatic defects of the metacarpophalangeal (MCP) joints in the thumb and index, middle and ring fingers from February 2006 to January 2008. Ten patients had acute injuries and five patients presented with old injuries. Researchers assessed active motion and pinch strength and compared all measurements to those from the opposite hand at follow-up. Researchers also compared preoperative and postoperative motion and pinch strength in patients with old MCP joint injuries. Researchers assessed hand function using the Disabilities of the Arm, Shoulder, and Hand questionnaire.
The mean motion arc of the reconstructed MCP joints was 46°, while the opposite joints were 91° at follow-up. The mean pinch strength of the injured joints was 5.4 kg and the opposite side was 7.1 kg. The mean preoperative motion arc was 2° with 1.6 kg pinch strength for the five patients with old injuries to the fingers and postoperative motion arc was 43° with 5.3 kg pinch strength. The mean Disabilities of the Arm, Shoulder, and Hand score was 9. However, the mean preoperative and postoperative scores of the five patients with old injuries were 44 and 17, respectively.
Perspective
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David C. Ring, MD, PhD
Salvage of metacarpophalangeal trauma with bone loss is tricky because there is no functional position for arthrodesis and arthroplasties are also imperfect for young, active patients. The problem at the proximal interphalangeal joint had an elegant solution in a non-vascularized osteoarticular autograft from the hamate bone. Because nonvascularized grafts resorb in some areas when transferred, and most metacarpophalangeal defects are easily accessed from dorsal, it is appealing to consider transferring a graft from the non-mobile third carpometacarpal joint on a retrograde dorsal metacarpal artery pedicle.
Zhang and colleagues used this technique in six thumbs, four index, four long, and one ring fingers. Ten were acute injuries and five old injuries. A minimum of 3 years later all the grafts were healed, the joint spaces were preserved, a few patients had pain, and an average of half the normal motion was achieved. It is not clear that the grafts need to be vascularized, but it seems relatively straightforward to transfer on a pedicle. This is a useful technique to keep in mind for these difficult and fortunately unusual problems.
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