Metacarpophalangeal joint reconstruction using a costal osteochondral graft: A case report

Abstract

Rationale: The conventional treatment of giant cell tumors is intralesional curettage with local adjuvant therapy. Because hand tumors have a high local recurrence, the primary goal for treating tumors of the hand is to eradicate the lesion. Patient concerns: To preserve the metacarpophalangeal (MCP) joint function as well as avoid further recurrence after surgery. Diagnoses: The giant cell tumor invades the patient’s MCP joint in an index proximal phalanx. Interventions: Using computer-aided design and three-dimensional printing techniques, we reformed the original shapes of the MCP joint and its peripheral bone to replica models. The surgeon then performed an en bloc resection and proximal phalanx with MCP joint reconstruction by fabricating the patient’s costal osteochondral graft during the operation. Outcomes: After 6 months of rehabilitation, the patient’s finger functions could pinch and grasp objects naturally. At the 1-year follow-up, the range of motion of the MCP, proximal interphalangeal, and distal interphalangeal joints improved from flexion of 35° to 60°, 75° to 85°, and 60° to 80°, respectively. The hand function achieved the mean performance of non-preferred hands for young females at the postoperative 3-year follow-up. Lessons: The customized prototyping technique has the potential to replica the original patient’s bony graft to reach the goal of minimizing the defects at the donor site and maximizing the function of the reconstructed MCP joint.