Osteochondral autograft transplantation for malunited intra-articular fracture of the proximal interphalangeal joint: a case report

Nobuo Yamagami,Yumiko Tsujimoto,Yuji Uchio,Soichiro Yamamoto

doi:10.1007/s00402-012-1622-4

Abstract

IntroductionMalunited intra-articular fracture of the proximal inter-phalangeal (PIP) joint sometimes causes problems, such as range of motion (ROM) limitation in the joint or lack of digital dexterity; however, the treatment method has not yet been established. We report a juvenile case of osteochondral autograft tranplantation to treat a malunited intra-articular fracture of the middle finger.Case reportA 14-year-old boy was injured at the right middle finger by a baseball impact and underwent conservative treatment. At 5 months after the injury, he complained of continuing pain and restricted ROM. Plain X-ray and CT images showed a bony defect in the articular surface of the PIP joint of the right middle finger. He was diagnosed with malunited intra-articular fracture of the PIP joint and underwent surgical treatment. First, through a palmar incision, a columnar-shaped drill hole was made at the recipient site of osteochondral defect. Then a cylindrical osteochondral plug, 4.5 mm in diameter, harvested from the knee, was inserted into the recipient hole and press-fitted. One year after surgery, the patient has neither pain nor ROM limitation of the finger and the knee joint. MRI showed smooth articular surface of the PIP joint.DiscussionThe benefits of our method include use of articular cartilage as a reconstruction material, availability for a relatively large cartilage defect, and stability of the autograft for the press-fitting method, which enable early mobilization exercise after surgery.

Highlights

Malunited intra-articular fracture of the proximal inter-phalangeal (PIP) joint sometimes causes problems, such as range of motion (ROM) limitation in the joint or lack of digital dexterity; the treatment method has not yet been established
The donor site was selected from a non-weight-bearing portion of the lateral condyle of the knee joint, as it consists of an articular cartilage and relatively large osteochondral plug can be harvested
The demerits include the invasiveness to the unaffected knee and requirement for presence of cortical bone in the periphery of the recipient hole

Summary

Discussion

Reconstruction methods for the finger joints include perichondral graft, articular implantation with vessels, an. As the patient desired to resume sports activity as early as possible, the fixation of the graft should be firm and rehabilitation exercise should be started early after surgery. Considering these factors, we chose to perform OAT harvested from the knee joint. Miyamoto et al [10] reported the oblique osteochondral plug transplantation technique for osteochondral autograft from the knee to treat osteochondritis dissecans of the elbow to enable insertion by avoiding the radial head Utilizing this technique, in the present study, we obtained the osteochondral autograft obliquely and inserted the graft by avoiding the head of proximal phalanx at hyper-extension position of PIP joint (Fig. 7). We consider osteochondral autograft from the knee to be effective for treatment of malunited intraarticular fracture of the proximal interphalangeal joint

Introduction