gms | German Medical Science

Objectives/Interrogation: Open intra-articular fractures of digital interphalangeal (DIP) joints occasionally destroy major amounts of joint cartilage and supporting bone with functional limitations.

Previous reports described the use of vascularized total joint transfers or not vascularized partial toe joint osteochondral autografts as unique alternatives to salvage proximal interphalangeal (PIP) joints with loss of one condyle when open reduction and internal fixation is not feasible.

We describe our experience of a free vascularized emi-joint transfer to salvage the DIP joint from open injury.

Methods: A 22 yo carpenter sustained an open fracture of the non-dominant left index finger middle phalanx (P2) with ulnar condylar loss. A homolateral vascularized 2nd toe proximal phalanx (P1) unicondylar transfer to the left index finger P2 head was undertaken. The defect was templated and a corresponding osteochondral graft was harvested from the head of the 2nd toe P1. The defect was measured intra-operatively and then a slightly larger graft than required was harvested, allowing for in situ adjustment. The osteochondral graft and medial collateral ligament, partial extensor tendon, the ipsilateral artery, vein and digital nerve were harvested and joined at the recipient site with microsurgical technique. The osteochondral graft was secured to the P1 head with 2 transverse 1,0 mm K-wires. All other composite tissues were sutured to the recipient site.

Results and Conclusions: The patient was splinted post-operatively and discharged on the 7th day. An early mobilization protocol of the injured finger was started with hand therapists. At 8 weeks post-operatively the two K-wires were removed. At 6-months follow-up, a pain-free active PIP joint range of motion (ROM) of 10-85° and DIP ROM of 10-50° were obtained, with a grip strength of 42 lbs. No donor site complications were found, and post-op. X-rays at 4 months and MRI at 6 months respectively revealed a good bone union, a normal vascular patency and bone viability of the unicondylar graft.

This report represents an example of vascularized toe unicondylar bone grafting as an alternative tool in the management of significant PIP injuries. In spite of technical demand, this procedure is a feasible and represents an ideal alternative surgical therapy in adults with > 5 mm bone loss and asking for a functional interphalangeal joint.