Reconstruction of an Entire Thumb Metacarpal

Abstract

Summary:This case report discusses the reconstruction of an entire thumb metacarpal after a diagnosis of giant cell tumor of bone. The patient underwent excision of the entire thumb metacarpal, followed by interposition of a tricortical iliac crest bone graft and metacarpophalangeal and carpometacarpal joint arthrodeses. This option allowed salvage of the patient’s native thumb with functional use as a stable post to which she can pinch and grasp objects. At 9 months postoperatively, there was no evidence of recurrence.

Reconstruction of the Second Metacarpal Bone after Bone Tumor Resection with Free Fibular Graft

“…Reviewing the literature, and especially considering the first ray, the are several accounts of techniques that involve resection and reconstruction with autologous graft from the fibula, iliac crest or metatarsals [2,6]. Regarding the metacarpophalangeal joint, arthrodesis and the use of silicone prostheses have been described, but especially in young and active patients, these options do not yield in most cases, a good functional result [3,6].…”

“…The first time this tumor was described was in the early nineteenth century by Astley Cooper (1818) [1]. These tumors account for 4-5% of all primary bone tumors, upto 20% are benign and typically involve the meta-epiphyseal region of long bones [2,3]. They are rarely found on the hand, corresponding only to 1-4% of all hand bone tumors [3].…”

“…These tumors account for 4-5% of all primary bone tumors, upto 20% are benign and typically involve the meta-epiphyseal region of long bones [2,3]. They are rarely found on the hand, corresponding only to 1-4% of all hand bone tumors [3]. Several treatments have been described, but in more advanced stages only the resection/ amputation of the affected segment can offer an effective cure.…”

Serratus Anterior-Rib Flap for the Reconstruction of Complex Defects Involving the First Metacarpal

“…Soft tissue defect of 50cm 2 , absence of the first metacarpal bone and thumb extensors (Pellegrini 2005;Jones et al 2012;Georgescu and Ivan 2003b) 6. Requirement to reconstruct the first metacarpal, the long extensor tendon of the thumb, and skin defect (Pellegrini 2005;Jones et al 2012, Ariff et al 2015Georgescu and Ivan 2003b;Smith and Brushart 1985;Hein et al 2016;Ariff et al 2015;Lim and Babineaux 2016;Gosal et al 2015;Punyaratabandhu et al 2017;Dhinsa et al 2011)…”

Conjoined Free Fibula Transplantation and First Carpometacarpal Joint Prosthesis for Functional Thumb Reconstruction—A Case Report

“…6,7 Local recurrence rate, high Campanacci stage, and surgical method, such as curettage, are significant risk factors for lung metastasis. 6 Treatment options include curettage 8 alone or in combination with local adjuvants, such as polymethylmethacrylate cement, alcohol, phenol, hydrogen peroxide, zinc chloride, 9 cryoablation with liquid nitrogen, 10 radiation, 11 supportive neoadjuvant systemic therapy with denosumab as an RANKL inhibitor, 5 resection, 12 or amputation, 2,13 whereby wide tumor resection has lower recurrence rates compared with simple curettage. However, wide tumor resection leading to large osseous defects especially with articular involvement significantly impairs hand function.…”