Abstract
Ankylosis of Proximal Interphalangeal Joint (PIPJ)of a finger can occur after intra-articular fractures, burns, degenerative conditions likerheumatoid arthritis. Not only are fingers with ankylosed PIP joints of little use for grip or grasp, but they are frequently injured because they do not follow the normal arc of the other fingers. An additional problem, though less so with the index finger, is the Quadriga effect, which can occur when profundus excursion is impaired with arthrodesis. Thus, ankylosis of Proximal Interphalangeal Joint of a finger in non-functional position can result in significant disability. Management of this problem varies from amputation to arthrodesis to arthroplasty. Many patients opt for arthroplasty as it improves range of motion and relieves pain. Proximal Interphalangeal Joint reconstruction has also been described using vascularised joint transfer and non vascularised autografts like perichondrium, costal cartilage.
We report 4 cases of Proximal Interphalangeal Joint ankylosis which were reconstructed using non vascularised conchal cartilage. The ankylosed portion of the joint was excised. Raw surfaces on either side were covered with conchal cartilage grafts. The grafts were fixed with sutures. Joint stability was achieved with PL grafts which were sutured on either side to periosteum covering the dorsal and volar aspects of the cartilage grafts.
We report here outcomes of the procedure with respect to pain, stability, range of motion and complications.
Keywords: Proximal interphalangeal joint ankylosis, conchal cartilage, arthroplasty.
References
- Littler JW, Thompson JS. Surgical and functional anatomy. In: Bowers WH ed. The Interphalangeal Joints. New York: Churchill Livingstone; 1987:142
- Foucher G, Hoang P, Citron N et al. Joint reconstruction following trauma: comparison of microsurgical transfer and conventional methods: a report of 61 cases. J Hand Surgery Br. 1986;11:388-393
- An K N, Chao E Y, Cooney W.P.et al. Forces in normal and abnormal hand. J Orthop Res. 1985;3:202-211
- Tsubokawa N, Yoshizu T, Maki Y. Long term results of free vascularized second toe joint transfers of finger proximal interphalangeal joints. J Hand Surg 2003; 28: 443-7.
- Hasegawa T, Yamano Y. Arthroplasty of the proximal interphalangeal joint using costal cartilage graft. J Hand Surg Br 1992; 17(5): 583-5.
- Sato K, Nakamura T, nakamichi N, Okuyama N, Toyama Y, Ikegami H. Finger joint reconstruction with costal osteochondral graft. Hand Surg 2001; 6(1): 1-11.
- Use of vascularised cartilage as an additional interposition in temporoman-dibular ankylosis surgery: Rationale, advantages and potential benefits. Mukund Jagannathan, Maksud Devale, Prashantha Kesari, and Siddharth Karanth. Indian J Plast Surg. 2008 Jul-Dec; 41(2): 110–115.
- Raja Sabapathy. Treatment of Mutilating Hand Injuries: An International Perspective. Hand Clinics, Volume 32, Issue 4, Pages
- Squitieri L, Chung KC. A systematic review of outcomes and complications of vascularized toe joint transfer, silicone arthroplasty, and pyrocarbon arthroplasty for posttraumatic jointreconstruction of the finger. Plast Reconstr Surg 2008; 121:1697–707.
- Branam BR, Tuttle HG, Stern PJ, etal. Resurfacing arthroplasty versus silicone arthroplasty for proximal interphalangeal joint osteoarthritis. J Hand Surg. 2007; 32:775-88.
- Hierner R1, Berger AK. Long-term results after vascularised joint transfer for finger joint reconstruction. J Plast Reconstr Aesthet Surg. 2008 Nov;61(11):1338-46.
Corresponding Author
Dr Rohit Munot
Assistant Professor, Dept of Plastic surgery, LTMG Hospital Sion, Mumbai-22, India
Ph No: +919860122763/ 02224043141, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i6.67
