Metacarpophalangeal joint reconstruction using a costal osteochondral graft: A case report.

RATIONALE: The conventional treatment of giant cell tumors is intralesional curettage with local adjuvant therapy. Because hand tumors have a high local recurrence, the primary goal for treating tumors of the hand is to eradicate the lesion. PATIENT CONCERNS: To preserve the metacarpophalangeal (MCP) joint function as well as avoid further recurrence after surgery. DIAGNOSES: The giant cell tumor invades the patient's MCP joint in an index proximal phalanx. INTERVENTIONS: Using computer-aided design and three-dimensional printing techniques, we reformed the original shapes of the MCP joint and its peripheral bone to replica models. The surgeon then performed an en bloc resection and proximal phalanx with MCP joint reconstruction by fabricating the patient's costal osteochondral graft during the operation. OUTCOMES: After 6 months of rehabilitation, the patient's finger functions could pinch and grasp objects naturally. At the 1-year follow-up, the range of motion of the MCP, proximal interphalangeal, and distal interphalangeal joints improved from flexion of 35° to 60°, 75° to 85°, and 60° to 80°, respectively. The hand function achieved the mean performance of non-preferred hands for young females at the postoperative 3-year follow-up. LESSONS: The customized prototyping technique has the potential to replica the original patient's bony graft to reach the goal of minimizing the defects at the donor site and maximizing the function of the reconstructed MCP joint.

Kinematic Investigation of Healthy, Arthritic, and Postsurgery Thumbs: Is the Metacarpophalangeal Joint the Gateway to Carpometacarpal Arthritis?

The thumb carpometacarpal (CMC) joint is one of the most likely joints to develop osteoarthritis (OA). If conservative treatments fail to alleviate symptoms, surgery may be pursued. Kinematic outcomes of CMC surgery techniques have been described, but current tools have limitations in capturing motion abilities. The goals of this study were (1) develop a new and robust set of kinematic outcome measures, and apply them to (2) a cohort of younger and older control individuals without CMC OA to determine age and sex-related changes, and (3) a cohort of participants with CMC OA before, 3 months, and 6 months after undergoing thumb ligament reconstruction with tendon interposition surgery to detect the impacts of surgery. 52 (26 males, 26 females) control and 18 (3 males, 15 females) surgical participants were tested. Kinematics were investigated using motion capture by mapping the three-dimensional motion space of the whole thumb, and two-dimensional motion boundaries of the metacarpal (MC) and proximal phalange (PP). Visual analog pain score was recorded. Older control participants had shifted regions of motion compared to younger participants (p ≤ 0.027), suggesting asymptomatic CMC wear. Control females had 31% more metacarpophalangeal (MCP) motion than control males (p = 0.013), which could alter loading paths through the CMC joint and increase OA risk. Pain at 6 months postsurgery was 72% less than presurgery (p < 0.001), but motion abilities were 20-28% less than presurgery (p ≤ 0.074) and 24-40% less than control participants (p ≤ 0.066). These techniques have the possibility of identifying presymptomatic motion changes, including those at the metacarpophalangeal joint in CMC OA progression.

The Application of Sesamoid Position in Diagnosing Thumb Metacarpophalangeal Joint Dorsal Dislocation: A Retrospective Study.

OBJECTIVES: The position of sesamoid of thumb metacarpophalangeal (MCP) joint changed clearly when the joint was dislocated dorsally. However, the significance of sesamoid location in diagnosing joint dislocation was unclear. The present study aimed to explore the positional relationship between sesamoid bone and thumb metacarpophalangeal joint in normal and dorsal dislocation joints. METHODS: Between January 2018 and August 2023, we collected 60 isometric plain films from sixty outpatients and reviewed 56 anisometric plain films from twenty-eight emergency patients with dorsal dislocation of thumb MCP joint at Tianjin Hospital, then took measurements on the hand X-ray images. The sesamoid length on its longitudinal axis was defined as DP, the distance between the distal edge of sesamoid and thumb MCP joint was defined as DJ, and the ratio of DJ and DP was R. An independent-samples t-test and paired-samples t-test was utilized to analyze difference among data groups. RESULTS: The 60 isometric images were from 30 male and 30 female outpatients with normal bone structure in their hands, and the 56 anisometric images of the 28 emergency patients included both preoperative and postoperative materials. Among the outpatients, the actual distance between the distal edge of sesamoid and thumb MCP joint space (DJ) was 2.09 mm and 1.40 mm in males and females, respectively. The authentic average length of sesamoid (DP) was 4.46 mm in males and 4.22 mm in females. The average value of R (the ratio of DJ and DP) in males and females was 0.49 and 0.34, respectively. There were gender-related statistical differences in DJ (p < 0.01) and R (p=0.01), but no statistical difference in DP (p > 0.05). For the 28 emergency patients, the mean value of R was -0.47 before joint reduction and 0.58 after joint reduction, with statistical difference between them (p < 0.01). CONCLUSIONS: There was significant difference in the relative position between sesamoid and thumb MCP joint when joint dislocation and joint reduction. The distal edge of sesamoid beyond thumb MCP joint could be an evidence in diagnosing joint dorsal dislocation. The distal edge of sesamoid below thumb MCP joint could be an evidence of joint reduction.

High Fracture Rate of AVANTA Silicone Implant Following Arthroplasty of the Thumb MCP Joint of Rheumatoid Arthritis Patients with Boutonniere Deformities.

We retrospectively investigated the mid-term outcomes of arthroplasty using the AVANTA silicone implant for thumb metacarpophalangeal (MCP) joints with boutonniere deformity in patients with rheumatoid arthritis (RA). This study involved 36 thumbs of 33 RA patients with a mean follow-up period of 5.1 years (range, 2.0-13.3). Postoperatively, the mean extension was significantly increased and the mean flexion was significantly decreased (p<0.001, p<0.001, respectively), resulting in the mean arc of range of motion (ROM) shifting in the direction of extension after surgery. Implant fracture was observed in 10 thumbs (28%), and 4 of these (11%) underwent revision surgery. The survivorship with implant fracture and revision surgery as endpoints were 73.4% and 91.8% at 5 years, respectively. The preoperative arc of ROM and the postoperative flexion range of the implant-fracture group were significantly greater than those in the no-implant-fracture group (p=0.039, 0.034, respectively). These results suggest the importance of patient education and careful rehabilitation to prevent excessive flexion. Overall, the AVANTA silicone implant showed a relatively high rate of implant fracture at our institute.

The influence of a tension band fixation as an adjunct for arthrodesis of the metacarpophalangeal joint in the horse.

OBJECTIVES: To determine the influence of a stainless-steel cable (SSC) tension band fixation as an adjunct to a locking compression plate (LCP) for arthrodesis of the equine metacarpophalangeal (MCP) joint. STUDY DESIGN: Experimental. An ex vivo biomechanical paired equine cadaver limb study. SAMPLE POPULATION: Five MCP joint pairs were collected from adult Thoroughbred horses, euthanized for reasons unrelated to orthopedic disease. METHODS: Each pair of MCP joints were randomly implanted with either a dorsally placed 5.5 mm LCP and a palmarly placed 2.0 mm SSC or a dorsally placed 5.5 mm LCP alone. Each construct was tested in cyclic loading followed by single cycle to failure in axial compression. Displacement at a target load of 1 kN over 3600 cycles at 1 Hz was recorded prior to single cycle to failure testing. RESULTS: In cyclic testing, displacement was not significantly different between the first and last 5% of testing cycles regardless of construct. Maximum displacement of each construct during cyclic testing was <1.1 mm. In single cycle testing, the observed yield point did not reveal any difference between LCP and LCP-SSC (p = .440). The maximum load at failure was significantly higher in LCP-SSC compared to constructs with the LCP alone (p = .046). CONCLUSION: The addition of the SSC to the LCP did not statistically affect construct displacement during cyclic loading or construct yield load during subsequent single cycle to failure. CLINICAL SIGNIFICANCE: This study provided much needed information regarding the necessity of a tension band SSC application in the arthrodesis of the MCP/MTP joint in horses.

The silicone metacarpophalangeal joint arthroplasty: An in-vitro analysis.

BACKGROUND: Silicone is still the gold standard implant in metacarpophalangeal arthroplasty. Whereas the clinical results are acceptable, in follow-ups with >10 years, high rates of implant fracture are common, and 5 to 7% of implants required revision. This work's purpose is to analyse the hypothesis that the joint flexion amplitude has a relevant effect on bone strain level, implant stress and bone-implant micromotion, which can reflect an increase in the risk of bone resorption/fatigue failure, implant fracture and osteolysis. METHODS: To experimentally predict the cortical loading behaviour, composite metacarpals and proximal phalanges were used in intact and implanted states. A finite element model was developed to evaluate the structural behaviour of cancellous bone and implant. This model was validated by comparing cortical strain and load-displacement curve with experimental measurements. FINDINGS: Bone strain changes between the intact and the implanted states showed a load transfer effect from the cortical to the cancellous bone that increases significantly with the flexion's amplitude rise. The peak implant stress occurred in the flexion amplitudes further away from the implant neutral angle. The highest implant pistoning motion and the highest phalanx cancellous-bone strain occurred simultaneously at the maximum flexion amplitude. INTERPRETATION: Limiting joint flexion range will be helpful to reduce the strain-shielding effect on cortical bone, minimizing the overload effect on cancellous bone and decreasing the stress levels and the pistoning motion on the implant, ultimately contributing to the longevity of silicone arthroplasty.

Satisfactory thumb metacarpophalangeal joint stability after ligament reconstruction with flexor digitorum superficialis in children with radial longitudinal deficiency.

We investigated thumb joint stability and patient-reported and functional outcomes a minimum of 1 year after flexor digitorum superficialis opponensplasty and ligament reconstruction in 23 thumbs of 20 consecutive children with radial longitudinal deficiency. In total, 15 thumbs had preoperative multidirectional instability in the metacarpophalangeal joint. We reconstructed 22 ulnar and 16 radial collateral ligaments. At follow-up, all the metacarpophalangeal joints were stable ulnarly. Seven metacarpophalangeal joints were unstable radially despite ligament reconstruction but had no related complaints. We recommend the flexor digitorum superficialis opponensplasty as a safe and reliable procedure in hypoplastic thumbs to create stability and augment thumb strength.Level of evidence: IV.

Techniques for Continuous Catheter Irrigation of a Septic Metacarpophalangeal Joint.

Septic arthritis of the metacarpophalangeal joint (MCPJ) compromises 9% of hand infections in Singapore. Common surgical treatment is open arthrotomy and joint washout. The wound is often left open for drainage postoperatively. Repeated debridement and secondary closure are frequently needed after the index surgery. We describe a method of continuous catheter irrigation of septic MCPJ joint using an infant feeding catheter. This method provides great infection clearance to avoid repeated debridement and allows primary closure of the wound to avoid secondary closure. This method also significantly reduces postoperative pain so that to facilitate early mobilization of the joint, which is crucial for functional recovery. We illustrate the techniques of this procedure and key points of postoperative management in the ward with case examples to demonstrate its simplicity, safety, and efficacy in treating MCPJ septic arthritis.

Implant-free anatomical reconstruction of thumb metacarpophalangeal joint chronic ulnar collateral ligament injuries.

A technique is described to treat chronic instability of the metacarpophalangeal joint of the thumb caused by rupture of the ulnar collateral ligament using a palmaris longus tendon graft without implants. Good results were obtained in eight patients.

[A V-Y shaped flap with digital artery nerve at metacarpophalangeal joint was used to repair the defect of middle and distal phalanx].

OBJECTIVE: To explore a surgical method for the reconstruction of volar soft tissue defect and sensory and vascular repair in middle and far phalangeal digits. METHODS: From January 2016 to January 2020, a total of 14 patients , 9 males and 5 females, ages ranging from 22 to 69 years old, and with volar soft tissue defects in the middle and distal digits 2 to 4, underwent surgical reconstruction using the V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint. The defect area was (2.0~2.5) cm×(1.5 ~2.0) cm. The procedure involved the harvest of a V-Y shaped flap with the digital artery and nerve from the metacarpophalangeal joint. Flap design, dissection of blood vessels and nerves, and anastomosis with the digital artery and nerve were performed according to a standardized protocol., Functional exercise of affected finger was initiated 3 weeks postoperatively. Subsequent assessments were conducted to evaluate finger pulp sensation, shape and other relevant parameters. According to the upper extremity functional evaluation standard set up by Hand Surgery Branch of Chinese Medical Association, the surgical outcomes were evaluated. RESULTS: All 14 cases demonstrated successful tissue transplantation, , with immediate recovery of sensation observed in 10 cases with distal finger pulp defects. Four patients with middle phalangeal defects experienced gradual sensory recovery within 2 to 3 months postoperatively. Thirteen patients were followed up for a mean duration of (8.8 ± 4.49) months, during which satisfactory outcomes were observed. The average two-point resolution of the finger pulp was 4-6mm, and sensory function evaluation yielded a score of S3 or above. Patients exhibited realistic finger shape, normal skin color and temperature, good wear resistance, and cold resistance. Furthermore, finger joint function was essentially normal. CONCLUSION: The V-Y shaped flap with digital artery and nerve at the metacarpophalangeal joint offers a suitable solution for repairing the defect of the middle or distal phalangeal finger. This technique is characterized by its simplicity, low risk, and favorable outcomes, including restored finger shape, blood supply and sensation. Moreover, high patient satisfaction was achieved.

Patient-Reported Outcomes and Function After Surgical Repair of the Ulnar Collateral Ligament of the Thumb.

PURPOSE: The purpose of this study was to report prospectively collected patient-reported outcomes of patients who underwent open thumb ulnar collateral ligament (UCL) repair and to find risk factors associated with poor patient-reported outcomes. METHODS: Patients undergoing open surgical repair for a complete thumb UCL rupture were included between December 2011 and February 2021. Michigan Hand Outcomes Questionnaire (MHQ) total scores at baseline were compared to MHQ total scores at three and 12 months after surgery. Associations between the 12-month MHQ total score and several variables (i.e., sex, injury to surgery time, K-wire immobilization) were analyzed. RESULTS: Seventy-six patients were included. From baseline to three and 12 months after surgery, patients improved significantly with a mean MHQ total score of 65 (standard deviation [SD] 15) to 78 (SD 14) and 87 (SD 12), respectively. We did not find any differences in outcomes between patients who underwent surgery in the acute (<3 weeks) setting compared to a delayed setting (<6 months). CONCLUSIONS: We found that patient-reported outcomes improve significantly at three and 12 months after open surgical repair of the thumb UCL compared to baseline. We did not find an association between injury to surgery time and lower MHQ total scores. This suggests that acute repair for full-thickness UCL tears might not always be necessary. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Thumb metacarpophalangeal joint morphology and reconstruction of the ruptured ulnar collateral ligament.

Studies on graft reconstruction techniques for ruptured thumb metacarpophalangeal (MCP) ulnar collateral ligaments (UCL) do not consider the variety of MCP joint morphology. Optimal reconstruction method for flat MCP joints is therefore unclear. Twenty-four fresh-frozen, human thumbs were tested for flexion, extension and valgus stability of the MCP joint. After resection of the UCL, four reconstruction methods, differing in the metacarpal origin and phalangeal attachment, were performed on each specimen, which were then tested again in the same way. Specimens were grouped as 'round' or 'flat' depending on morphometric parameters and group differences were analysed. In flat joints, only the non-anatomical Glickel reconstruction and a modified Fairhurst reconstruction maintained normal mobility and stability. In round joints, only the Glickel reconstruction maintained normal mobility and stability. The original Fairhurst method and a modification with the origin palmar in the metacarpus were disadvantageous in both flat and round joints.

Does Irreducibility Always Mean a Complex Dislocation? An Analysis of 33 Pediatric Metacarpophalangeal Joint Dislocations.

BACKGROUND: Previous failed reduction and certain radiographic indicators historically have been used to differentiate simple and complex metacarpophalangeal joint (MPJ) dislocations in children, the latter of which warrants open reduction. This investigation aimed to determine the necessity for open reduction with these indicators and establish a new treatment algorithm and educational focus for these rare injuries. METHODS: A 12-year retrospective study was conducted on all children with MPJ dislocations at a single pediatric hospital. The rates of successful closed reduction, number of reduction attempts, and radiographic findings were detailed. Operative details and postoperative outcomes were also gathered. RESULTS: Thirty-three patients with a mean age of 11.1 years were included. Most were male [ n = 27 (82%)] and had undergone two or more previous reduction attempts at an outside facility. Stable closed reduction was then achieved outside of the operating room in five patients and in the operating room under general anesthesia in another 14, for a total of 19 of 33 patients (57.6%). The thumb was injured most often [ n = 19 (57.6%)] and more likely to undergo successful closed reduction ( P = 0.04). There was no relationship between number of previous reduction attempts and ability to achieve closed reduction ( P = 0.72). Neither joint-space widening nor proximal phalanx bayonetting was correlated radiographically with failure of closed reduction ( P = 0.22 and P = 1, respectively). CONCLUSIONS: This study supports closed reduction of pediatric MPJ dislocations in the operating room under general anesthesia before conversion to open reduction, regardless of injury characteristics or previous reduction attempts. This strategy is likely to limit unnecessary open surgery and related risks. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, IV.

Intracapsular Chondroma Occurring in Metacarpophalangeal Joint of the Hand: A Rare Presentation.

Extraskeletal chondroma comprises synovial chondromatosis, intracapsular chondroma and soft tissue chondroma, its presentation in the hand, however, is very rare. A 42-year-old woman presented with a mass around right fourth metacarpophalangeal (MCP) joint. She had no pain or discomfort in activities. The radiographs showed soft tissue swelling, but no calcification or ossifying lesions. The magnetic resonance imaging (MRI) showed a lobulated juxta-cortical encircling mass existing around the fourth MCP joint. We did not suspect any cartilage-forming tumour in MRI. The mass was easily removed because there was no adhesion with surrounding tissues and the specimen had the appearance of a cartilage. The histological diagnosis was chondroma. Based on the tumour location and histological results, we diagnosed it as intracapsular chondroma. Although intracapsular chondroma is very rare-ly seen in the hands, it is important to consider an intracapsular chondroma when differentiating a tumour in the hand because it is difficult to diagnose one in an imaging examination. Level of Evidence: Level V (Therapeutic).

Pathological anatomy, classification and treatment of the atypical Wassel Type VI thumb duplication.

We studied the pathological anatomical structures of atypical Wassel Type VI thumb duplication to provide a theoretical basis for surgical treatment. Forty-seven patients with atypical Wassel Type VI thumb duplication were treated. We found that some of cases had an ulnar thumb without an extensor tendon, or without a flexor tendon, or without both. All the ulnar metacarpal bones were abnormal to variable degrees. On-top-plasty is currently the best procedure for the treatment of this type of anomaly. Flexor tendon reconstruction is an important factor in functional reconstruction of the thumb, and keeping the pulley and sheath intact is a key step in flexor tendon reconstruction. Placing the on-top-plasty level at the distal end of the metacarpal or at the proximal phalanx depends on the presence of the flexor tendon. According to the condition of the flexor tendon, the atypical Wassel Type IV duplication can be divided into two types: the absent type and the intact type.Level of evidence: VI.

Metacarpophalangeal Joint Reconstruction by Vascularized Partial Metatarsophalangeal Joint Transplantation: A Case Report.

CASE: A 27-year-old man underwent metacarpophalangeal joint reconstruction of his right middle finger using vascularized tissue from the distal component of the metatarsophalangeal joint of the right second toe. The donor site was reconstructed using a portion of the iliac bone and overlying tendinous fiber. The reconstructed metacarpophalangeal joint was stable 2 years postoperatively, and the arc of active motion was 80°. The reconstructed metatarsophalangeal joint did not interfere with walking. Radiography revealed the satisfactory condition of these joints. CONCLUSION: Depending on the type of defective joint and soft tissue injuries, vascularized partial joint transplantation could be considered for reconstruction.

Clinical and functional outcomes of surgical treatment of grade III ulnar collateral ligament injuries of thumb metacarpophalangeal joint.

OBJECTIVES: The aim of this study was to compare the clinical and functional outcomes of three surgical techniques (subperiosteal suture, bone anchor and direct repair) for the management of severe acute ulnar collateral ligament injuries of the thumb metacarpophalangeal joint with a minimum of 1 year follow-up. MATERIAL AND METHODS: Between 2015 and 2020, 230 collateral ligament injuries required surgical treatment in our department. After the inclusion and exclusion criteria were applied, 100 were included in the study. The Glickel score and functional scores such as QuickDASH and PRWE were assessed. Time to return to work and to sport was quantified. RESULTS: Ulnar collateral ligament injuries affected men who were statistically younger than women (41.8 years old vs 48.3). Subperiosteal suture was the preferred technique (81%), then bone anchor reattachment (12%) and direct repair (7%). All three techniques produced excellent stability (91-100%). Better range of motion was reported in the subperiosteal group, but better strength was found in the bone anchor group. Subperiosteal suture had 89% excellent and good results, while there was 83% in the bone anchor group and 71% in the direct repair group. Mean time to return to work was 2 months in the bone anchor group versus 3 months in the subperiosteal group. Mean QuickDASH was 8.7/100 and mean PRWE was 7.1/100. CONCLUSION: This is the biggest case series to date on surgical treatment of severe ulnar collateral ligament injuries of the thumb metacarpophalangeal joint. The subperiosteal technique is simpler and less expensive. While the results are not often described in the literature, it produces comparable clinical and functional outcomes to bone anchor reattachment with a minimum follow-up of 1 year.

Histology of the volar plate of the thumb metacarpophalangeal joint.

BACKGROUND: The aim of the study was to describe the histology of the thumb MCPJ volar plate. METHODS: Five fresh-frozen thumbs were dissected. The volar plates were harvested from the thumb MCPJ. Histological analyses were performed using 0.04% Toluidine blue and counterstained with 0.005% Fast green. RESULTS: The thumb MCPJ volar plate comprised two sesamoids, dense fibrous tissue and loose connective tissue. The two sesamoids were connected by dense fibrous tissue, with collagen fibers oriented transversely (perpendicular to the long axis of the thumb). In contrast, the collagen fibers within the dense fibrous tissue on the lateral sides of the sesamoid were oriented longitudinally in line with long axis of the thumb. These fibers blended with the fibers of the radial and ulnar collateral ligaments. The collagen fibers in the dense fibrous tissue distal to the sesamoids ran transversely, perpendicular to the long axis of the thumb. The proximal aspect of the volar plate showed only loose connective tissue. The volar plate of the thumb MCPJ was largely uniform with no division of layers from the dorsum to the palmar surface. There was no fibrocartilaginous component in the thumb MCPJ volar plate. CONCLUSIONS: The histology of the volar plate of the thumb MCPJ differs significantly from the conventional understanding of the volar plate, based on the volar plate of finger proximal interphalangeal joints. The difference is likely due to the presence of the sesamoids, which confer additional stability, reducing the need for a specialized trilaminar fibrocartilaginous structure with the lateral check-rein ligaments found in the volar plate of finger proximal interphalangeal joints to confer additional stability.

[Open metacarpophalangeal dislocation]. / La luxation métacarpo- phalangienne ouverte.

Open metacarpophalangeal dislocation Abstract. Dislocation of a finger is a pathology often encountered in emergency centers. The following case example provides a reminder of its management and the situations in which the patient should be referred to the specialist.

Résumé. La luxation d'un doigt est une pathologie souvent rencontrée dans les centres d'urgence. L'exemple du cas suivant permet un rappel sur sa prise en charge et les situations dans lesquelles le patient doit être référé au spécialiste.