Cavadas Pedro C, Landin Luis, Thione Alessandro
Department of Reconstructive Surgery, Clínica Cavadas, Valencia, Spain.
J Hand Surg Am. 2010 Aug;35(8):1275-81. doi: 10.1016/j.jhsa.2010.04.013. Epub 2010 Jul 8.
Traumatic defects of the condyles of the proximal phalanx (P1) are challenging injuries. Use of osteochondral grafts from the hamate had been described for defects of the base of the middle phalanx. Extending this concept, the purposes of this study were to see whether an osteochondral graft from the base of the little finger metacarpal was anatomically feasible to reconstruct a condyle of P1, and to determine whether the reconstructions performed were clinically successful.
We measured the radius of curvature of the base of M5 and the condyles of P1 of the 4 fingers in 15 dry hand skeletons and compared them. We retrospectively reviewed 15 patients with traumatic loss of one condyle of P1. In addition, 16 osteochondral grafts from the ulnar side of the base of the M5 were harvested, tailored to reconstruct the defect, and fixed with screws. Average follow-up was 4.8 years (range, 1-7.5 y). We measured the active arc of motion of the proximal interphalangeal joint.
The radius of curvature of the base of M5 was 5.6 mm (range, 4.2-7.2 mm), whereas the radiuses of curvature of the condyles of P1 of the index and long fingers were 4 mm, and those of the ring and little fingers were 3.8 mm. The radius of curvature of the base of the M5 was 40% and 47% larger than that of the P1 condyles of the index-long and ring-little fingers, respectively. The active arc of motion of the proximal interphalangeal joint in the clinical cases averaged 49 degrees (range, 20 degrees to 100 degrees ). There was partial graft resorption without pain, instability, or notable loss of arc of motion. There was no severe donor-site morbidity.
The base of the M5 is a suitable donor site of osteochondral grafts for the condyles of P1 based on anatomical grounds. The series reported, though short and nonhomogeneous, suggests that the medium-term results of this technique are acceptable.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
近端指骨（P1）髁的创伤性缺损是具有挑战性的损伤。已有文献报道使用来自钩骨的骨软骨移植治疗中节指骨基底的缺损。扩展这一概念，本研究的目的是观察来自小指掌骨基底的骨软骨移植在解剖学上是否可行以重建P1的髁，并确定所进行的重建在临床上是否成功。
我们测量了15个干燥手部骨骼中第5掌骨基底以及4根手指P1髁的曲率半径并进行比较。我们回顾性分析了15例P1一个髁创伤性缺失的患者。此外，从第5掌骨基底尺侧获取16个骨软骨移植块，根据缺损情况进行修整，并用螺钉固定。平均随访时间为4.8年（范围1 - 7.5年）。我们测量了近端指间关节的主动活动弧度。
第5掌骨基底的曲率半径为5.6毫米（范围4.2 - 7.2毫米），而示指和中指P1髁的曲率半径为4毫米，环指和小指的为3.8毫米。第5掌骨基底的曲率半径分别比示指 - 中指和环指 - 小指P1髁的曲率半径大40%和47%。临床病例中近端指间关节的主动活动弧度平均为49度（范围20度至100度）。存在部分移植块吸收，但无疼痛、不稳定或明显的活动弧度丧失。没有严重的供区并发症。
基于解剖学依据，第5掌骨基底是用于P1髁骨软骨移植的合适供区。尽管本系列报道的病例数较少且不均衡，但提示该技术的中期结果是可接受的。
研究类型/证据水平：治疗性IV级。
