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Reconstruction of the proximal phalanx head with a costal osteochondral graft for a comminuted fracture of the proximal interphalangeal joint

Yoshihiko Satake, Mitsuhiko Nanno, Norie Kodera, Shinro Takai
Journal of Nippon Medical School 2019 November 28
31776319
We herein report a case involving a 41-year-old male carpenter who underwent costal osteochondral grafting with a pins and rubbers traction system (PRTS) for a complex cartilage defect of the proximal interphalangeal (PIP) joint. He had inadvertently cut his finger incompletely off with a power saw. The skin laceration extended to the dorsal aspect of his ring finger, and he had incomplete loss of the ulnar condyle and comminution of the radial condyle of the proximal phalanx of the PIP joint. He was diagnosed with an intra-articular PIP joint open fracture of the left ring finger with a 60% defect of the proximal phalanx joint surface. PIP joint reconstruction was performed with a costal osteochondral graft 3 weeks after the injury. The graft was harvested at the osteochondral junction of the fifth rib. The volar side of the proximal phalanx cortex and the condyles of the proximal phalanx on each side, which included the origin of the collateral ligaments, were preserved. The graft was shaped to match the defect, and biplane fixation with three miniscrews was subsequently performed. Finally, a PRTS was attached. At 6 months postoperatively, the patient returned to his job; at 12 months postoperatively, he had a stable, pain-free joint. This technique enables preservation of the joint stabilizers and rigid fixation of the graft, resulting in a good outcome. Our modified costal osteochondral graft with a PRTS is useful for severe intra-articular fractures of the PIP joint and should be considered prior to salvage procedures.

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