Re: Total joint reconstruction for MP joint ankylosis using costal osteochondral graft: A case report

摘要

Dear Sir, A 33 year-old right-handed male truck driver developed an ankylosed right middle finger MP joint following infection after a fight bite injury. The MP joint was ankylosed at 10?of flexion. The PIP and DIP joints ranged 0?90?and 0?60? respectively. Radiograph confirmed bony ankylosis (Fig 1A). Total MP joint replacement using costal osteochondral auto-grafts was performed 6 months after the initial injury. At operation, there was a 5 cm defect in the extensor tendon probably from surgical treatment of the original injury (Fig 1B). The soft tissues, including periosteum, collateral ligaments and volar plate, were mobilised. The joint was excised and replaced with two pieces of osteochondral graft which had been harvested from the fifth and sixth ribs through an ipsilateral transverse sub-mammary incision, and shaped to form the metacarpal head and base of the proximal phalanx. The cartilaginous area of the graft was trimmed using a scalpel, and it should be as thin as possible. Careful trimming was necessary to form a matching pair of articular surfaces of the MP joint with adequate contour. The grafts were step-cut and stabilised using mini-screws (Fig 1C-E). After immobilisation in a forearm plaster for 2 weeks, passive extension and active flexion exercises were started. At 4 months when there was a passive range of movement of 10deg/90deg, the tendon defect was grafted using palmaris longus tendon.