|Rheumatoid arthritis commonly affects the hands in a variety of ways. Although more effective medications have lessened the number of patients requiring reconstruction for rheumatoid hand deformities, surgery is needed for some cases. This case demonstrates MCP arthroplasty using bone graft from the metacarpal head to recreate the dorsal cortex of the proximal phalanx lost from chronic subluxation.|
|Click on each image for a larger picture|
|This woman has undergone
multiple rheumatoid procedures elsewhere. On the right, these included
right wrist fusion and MCP silicone arthroplasties. On the left,
silicone arthroplaties of the thumb MCP, index and middle PIP joints
and arthrodesis of the thumb IP, ring and small PIP koints. She
wanted improvement of her left hand function, which was hindered by
wrist pain and flail fingers.
|Her left index and middle
fingers are grossly unstable.
|Xrays show radiocarpal
collapse, proximal migration of the proximal phalanges, flail PIP
joints and loss of the proximal half of the dorsal cortex of the
|Her greatest desire was
pinch reconstruction. This was approached in two stages: wrist fusion,
implant removal and fusion of the index and middle PIP joints, followed
by index and
middle MCP arthroplasties. There are several alternative approaches,
including index MCP fusion and revision PIP arthroplasties.
Below are xrays after the first set of reconstructions.
|For the second stage of her
reconstruction, the index proximal phalanx did not have adequate dorsal
cortex to support an implant arthroplasty, and bone graft from the
metacarpal head was used to reconstruct this.
|The technique is shown in
|Final radiographs, three
silicone implant arthroplasty
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