Reconstruction of the first metacarpal bone with an autologous non-vascularized fibular graft after enchondroma resection

Sahan, Ismail; Blatt, L.-A.; Deken, Julie De; Anagnostakos, Konstantinos; Meyer, C

doi:10.1016/j.hansur.2021.04.008

Hand Surgery and Rehabilitation

2021

DOI: 10.1016/j.hansur.2021.04.008

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Reconstruction of the first metacarpal bone with an autologous non-vascularized fibular graft after enchondroma resection

Ismail Sahan

L.-A. Blatt

Julie De Deken

et al.

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Cited by 2 publications

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“…Current options for the reconstruction of large metacarpal defects include the interposition of medial femoral condyle flaps with 14 or without 3-dimensional printed models, 15–17 nonvascularized fibular grafts, 18 fibular bone allografts, 19,20 nonvascularized metatarsal grafts, 21,22 and reverse radial artery bone flaps 23 . Combined defects of the carpometacarpal (CMC)-1 joint with loss of the trapezium and the first metacarpal have been reconstructed with medial femoral condyle flaps and arthrodesis 16 or suspension arthroplasty 24 .…”

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confidence: 99%

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

Rein,

Geister,

Kremer

2023

Ann Plast Surg

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Background Giant cell tumors grow locally invasive with osseous and soft tissue destruction, requiring wide resection to avoid recurrence. Stable reconstruction of the first carpometacarpal (CMC-1) joint remains a challenge due to its high range of mobility. The latter is of paramount for the functionality of the hand. Purpose Therefore, the aim of this study was to report our approach for a combined reconstruction of the first metacarpal and the CMC-1 joint. Methods A 58-year-old woman underwent wide resection of a benign giant cell tumor at the base and shaft of the first metacarpal of the left thumb. Because of the loss of the CMC-1 joint and the instability of the thumb, an osseous reconstruction using a vascularized fibular graft combined with a TOUCH Dual Mobility CMC-1 prosthesis was performed to reconstruct the CMC-1 joint. Results Osseous healing was observed after 3 months. No tumor recurrence and good joint function were documented at the follow-up investigation after 1 year. The patient reported only minor restrictions during activities of daily living. Thumb opposition was possible with a Kapandji score of 8/10. A slight pain while walking remained as a donor-side morbidity at the right lower leg. Conclusion Metacarpal reconstruction with vascularized fibula bone grafts allowed a combined joint reconstruction with a commercially available prosthesis, which is an approach to restore the complex range of motion of the thumb.

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mentioning

confidence: 99%

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

Rein,

Geister,

Kremer

2023

Ann Plast Surg

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3D‐Printed Metacarpal Prosthesis in the Treatment of Primary Osteosarcoma of the First Metacarpal: A Novel Surgical Technique

He,

Tian,

Zou

et al. 2024

Orthopaedic Surgery

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ObjectiveOsteosarcoma at the first metacarpal is extremely rare. Reconstructing the metacarpal after tumor resection is essential, as the thumb accounts for approximately 40%–50% of hand function. Although autografts, arthroplasty, and transposition have been reported as reconstruction options, their use is limited by complications such as secondary injury, nonunion, and displacement. In this study, we present a case of a patient with first metacarpal osteosarcoma who underwent tumor resection followed by reconstruction with a 3D‐printed metacarpal prosthesis. We tend to introduce a novel strategy to reconstruct the first metacarpal and restore the hand function.MethodsA 30‐year‐old male with 5‐month history of first metacarpal swelling in the left hand was admitted to our center. Imaging examinations and incision biopsy confirmed a diagnosis of intramedullary well‐differentiated osteosarcoma. A 3D‐printed metacarpal prosthesis was then designed to achieve carpometacarpal (CMC) joint fusion and thumb metacarpophalangeal (MCP) joint reconstruction. Postoperative evaluations included X‐ray and tomosynthesis‐shimadzu metal artifact reduction technology (T‐SMART) imaging to assess bone‐prosthesis integration. Hand function was measured using the Musculoskeletal Tumor Society (MSTS) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe tumor was completely resected, and a 3D‐printed metacarpal prosthesis was performed to reconstruct the tumor defect. Postoperative imaging showed that the interface between bone and prosthesis was integrated and that there was no loose, displacement, or fracture of the implant. At the last follow‐up, the patient had an MSTS score of 25/30 and a DASH score of 8/100. The range of motion on thumb MCP joint was 30° of flexion and 0° of extension. The Kapandji thumb opposition score was 4 points. The grip strength was 9 kg (compared to 30 kg on the contralateral side) and the key‐pinch strength was 3 kg (compared to 8 kg on the contralateral side).Conclusion3D‐printed metacarpal prosthesis could be an effective reconstruction option for patients with low‐grade malignant tumors. Themulti‐planar fixation achieved through 3D surgical planning helps maintain thumb function and restore overall hand function.

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Reconstruction of the first metacarpal bone with an autologous non-vascularized fibular graft after enchondroma resection

Cited by 2 publications

References 7 publications

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

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

3D‐Printed Metacarpal Prosthesis in the Treatment of Primary Osteosarcoma of the First Metacarpal: A Novel Surgical Technique

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