-Case Reports-

Use of a Costal Osteochondral Graft for Reconstruction of a Proximal Phalanx Head with a Comminuted Fracture of the Proximal Interphalangeal Joint

Yoshihiko Satake^1,2, Mitsuhiko Nanno², Norie Kodera² and Shinro Takai²

¹Department of Orthopedic Surgery, International University of Health and Welfare Hospital, Tochigi, Japan
²Department of Orthopedic Surgery, Nippon Medical School, Tokyo, Japan

We report the use of costal osteochondral grafting with a pins and rubbers traction system (PRTS) for treatment of a complex cartilage defect of the proximal interphalangeal (PIP) joint in a 41-year-old male carpenter who had inadvertently incompletely severed his finger with a power saw. The skin laceration extended to the dorsal aspect of his ring finger and resulted in incomplete loss of the ulnar condyle and comminution of the radial condyle of the proximal phalanx of the PIP joint. The diagnosis was intra-articular PIP joint open fracture of the left ring finger with a 60% defect of the proximal phalanx joint surface. Three weeks after the injury, PIP joint reconstruction was performed with a costal osteochondral graft harvested at the osteochondral junction of the fifth rib. The volar side of the proximal phalanx cortex and the condyles of the proximal phalanx on each side, which included the origin of the collateral ligaments, were preserved. The graft was shaped to match the defect, and biplane fixation with three miniscrews was subsequently performed. Last, a PRTS was attached. At 6 months postoperatively, the patient returned to his job; at 12 months postoperatively, the joint was stable and free of pain. This technique enabled preservation of joint stabilizers and rigid fixation of the graft, resulting in a good outcome. Our modified costal osteochondral graft with a PRTS is useful for severe intra-articular fractures of the PIP joint and should be considered before salvage procedures.

J Nippon Med Sch 2020; 87: 37-42

Keywords
costal osteochondral graft, proximal interphalangeal joint, fracture, external fixation, surgery

Correspondence to
Yoshihiko Satake, Department of Orthopedic Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasu-shiobara, Tochigi 329-2763, Japan
y-satake@nms.ac.jp

Received, September 26, 2019
Accepted, October 30, 2019