[Reconstruction of phalanx and metacarpal defects by autologous iliac crest transplants after tumour resection with joint involvement].
BACKGROUND
The reconstruction of large phalanx or metacarpal defects after tumour resection is still a challenge. In contrast to orthopaedic oncology there are no modular prostheses available in hand surgery. If the tumour affects the joint, often the only therapeutic option is an arthrodesis of the joint with a bone graft. In this study, a technique of joint reconstruction with an autologous bone graft from the iliac crest is presented.


METHODS
Curative tumour resection is the main goal of the operation, including hemiresection of a finger joint if necessary. The bony defect is reconstructed with a bone graft from the iliac crest which is prepared to match the opposite joint surface as nearly as possible. An additional arthroplasty with the palmar plate might be performed. Postoperative care includes either 6 weeks transfixation of the affected joint with a K-wire or, if possible, early joint motion with a dynamic external fixateur. The operation technique and postoperative treatment are described; further the clinical and radiological follow-ups of three patients are shown and a review of the literature is given.


RESULTS
The replacement of larger parts of the phalanx or metacarpal bone revealed good results with regard to joint movement of the partly replaced metacarpophangeal joint (MCP). Besides a good functional outcome patients were also nearly pain-free. Regarding the proximal interphalangeal (PIP) joint after resection of the middle phalanx, limited movement was found on the basis of a rapidly developing osteoarthritis, however, being accompanied by tolerable pain.


CONCLUSIONS
The usage of autologous iliac crest transplants for reconstruction of metacarpal or phalanx defects which include one partner of the MCP joint can be advised after tumour resection, especially because of rare functional alternatives. Bone defects including one part of the PIP joint might also be replaced by iliac crest transplants. However, the functional outcome seems to be less attractive than in MCP reconstruction. In cases of development of osteoarthritis after iliac crest transplantation, arthroplasty with silicone spacers might be a salvage procedure to maintain joint movement.
Sektion Hand- und Mikrochirurgie, Stiftung Orthopädische Universitätsklinik Heidelberg, Heidelberg, Germany. martin.jung@ok.uni-heidelberg.de
M
M
Jung
W
W
Daecke
L
L
Bernd
A-K
AK
Martini
K
K
Schroeder
D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D017824:Bone Cysts, Aneurysmal / Q000175:diagnosis / Q000601:surgery*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016025:Bone Transplantation; D001864:Bone Wires; D002812:Chondroma / Q000175:diagnosis / Q000601:surgery*; D002813:Chondrosarcoma / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005384:Finger Joint / Q000473:pathology / Q000601:surgery*; D050278:Finger Phalanges / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D050279:Metacarpal Bones / Q000473:pathology / Q000601:surgery*; D008662:Metacarpophalangeal Joint / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000601:surgery; D011182:Postoperative Care; D012086:Reoperation