Reconstruction of finger joints

Finger joints play critical role in the function of the hand. Their function can be absent or disturbed by many reasons such as trauma, arthritis, tumor or congenital anomalies. The alternatives for management of affected joints include amputation, arthrodesis, reconstruction with prosthetic materials and spacer, joint transplantation with vascularized or nonvascularized. Author introduces a couple of methods in small joint reconstruction of hand. We performed distraction followed by gradual increase range of joint motion gradually via hinged external fixation device in minimally arthritic changed joints. Author performed 4 cases of that procedure in the proximal interphalangeal joints of traumatic ankylosing joints since June 1997. We can get average 40 degree of the interphalangeal joint motion from total ankylosis and corrected deformities such as fixed flexion contractures. In the cases with severe defects of one side of the joint, we performed biologic hemi-arthroplastic joint reconstruction with costal osteochondral transplantation from May 1993. Etiologies of the joint defect were five post-traumatic ankylosis, two tumor resection eases. Pre-operative range of joint motion were impossible in post-traumatic ankylosis patients, destroyed joint surface by involvement of tumor tissue in tumor patients. Post-operative joint motion ranges were average 45 degree in post-traumatic ankylosis and 80 degree finger flexion in tumor cases. Distraction followed by gradual increase joint motion with hinged external fixation technique is helpful in the cases of the finger joint ankysosis without significant bone and cartilage defect. In cases with significant defective bone and cartilage especially one side of the joint, osteochondral rib transplantation is one of the useful options in the proximal interphalangeal joint and metacarpophalangeal joint reconstruction.