title: Reconstruction of an entire metacarpal and metacarpophalangeal joint using a fibular osteocutaneous free flap and silicone arthroplasty.
abstract: Radical resection of the entire ring finger metacarpal for a giant cell tumor resulted in a bony defect extending from the distal surface of the hamate to the proximal surface of the proximal phalanx. We reconstructed the metacarpal with a custom-contoured free fibular osteocutaneous flap and maintained motion at the new fibulophalangeal joint using a silicone arthroplasty. At 4.5 years postoperatively, the patient has shown no signs of recurrence of the giant cell tumor. The silicone arthroplasty has maintained 15° to 85° of motion at the new joint. Because of its similar shape to a metacarpal and because it allows faster bony healing compared with a nonvascularized fibular bone graft, a free vascularized fibular bone graft is an ideal candidate for reconstruction of extensive defects of the metacarpals, and placement of a silicone spacer in its distal medullary cavity can preserve motion at the new metacarpophalangeal joint.
authors.affiliation: University of California Irvine Center for Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, University of California Medical Center, Orange, CA, USA.
authors.forename: Neil F
authors.initials: NF
authors.lastname: Jones
authors.forename: Brian P
authors.initials: BP
authors.lastname: Dickinson
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hansen
mesh_terms: D000368:Aged; D050806:Arthroplasty, Replacement, Finger / Q000379:methods*; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005360:Fibula; D058752:Free Tissue Flaps; D018212:Giant Cell Tumor of Bone / Q000473:pathology / Q000601:surgery*; D006801:Humans; D050279:Metacarpal Bones / Q000601:surgery*; D008662:Metacarpophalangeal Joint / Q000601:surgery*; D012828:Silicones
chemical_list: D012828:Silicones