PMC6211214_01
Case 1. (A) Local findings at admission. Arrows show noticeable swelling and erythema on the dorsum of the second finger metacarpophalangeal joint. (B) Partial defect of the second metacarpal head due to infection.
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Three weeks later, the patient visited our hospital with noticeable swelling, erythema, and tenderness on the dorsum of the MCP joint of her second finger (Figure 1(A)). During surgery, a partial lesion of the second metacarpal head due to infection was found, and necrotic and infectious bone was removed completely (Figure 1(B)).
Case 1. (A and B) CT images showing the second metacarpal head defect.
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However, she could not move her right second finger MCP joint without pain due to the second metacarpal head defect (articular defect size: 13 x 10 mm) (Figure 2).
Case 1. A third metacarpal base osteoarticular flap was harvested.
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Therefore, the patient was treated with a third metacarpal base osteoarticular flap for the right second metacarpal head defect (Figure 3).
Case 1. (A) The vascularised bone fragment was fixed with K-wires. (B) Bone union of the vascularised bone graft was obtained at the articular surface of the MCP joint at final follow up.
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The vascularised bone fragment was fixed with two K-wires (1.0 mm) (Figure 4(A)), taking care to restore the continuity and contour of the articular surface as much as possible. Plain radiographs showed bone union after POW 8 (Figure 4(B)) and the patient returned to her work (nurse) and normal daily activity at POW 18 (Figure 5).
Case 1. (A and B) A good functional outcome was obtained.
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Plain radiographs showed bone union after POW 8 (Figure 4(B)) and the patient returned to her work (nurse) and normal daily activity at POW 18 (Figure 5).
PMC6211214_02
Case 2. (A) Noticeable swelling, erythema, and pus-like discharge on the dorsum of the third MCP joint. (B) The arrow shows a visible tooth sign in an oblique radiographic view.
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One week later, the patient visited our hospital with noticeable swelling, erythema, tenderness, and pus-like discharge on the dorsum of his third MCP joint (Figure 6(A)). Radiographs showed a visible tooth mark at the third metacarpal head (Figure 6(B)). A partial lesion of the extensor and the second metacarpal head due to bite and infection was found (Figure 6(B)).
Case 2. (A) Intraoperative view showing the partial lesion of the extensor and the second metacarpal head due to bite and infection. (B) CT showing the third metacarpal head defect and the narrowed joint space.
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A large defect of the third extensor and third metacarpal head occurred due to the repeated debridements (articular defect size: 18 x 15 mm) (Figure 7(A)). Therefore, the patient was treated with an osteochondral vascularised medial femoral trochlea (MFT) flap for the third metacarpal head defect (Figure 7(B)).
Case 2. (A) An osteochondral vascularised MFT flap was harvested. (B) The flap was transferred to the third metacarpal head defect.
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This segment was harvested on the transverse branch and common descending geniculate artery (DGA) (Figure 8(A)). DGA vessels were end-to-end anastomosed to the radial artery and accompanying vein at the snuff box (Figure 8(B)).
Case 2. (A) The osteochondral bone segment fixed by K-wires. (B) Radiography showed a thick layer of cartilage at the MCP joint without joint space narrowing at final follow up.
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Fixation was achieved with two K-wires (1.2 mm) through a dorsal approach at the MCP joint (Figure 9(A)). X-ray showed a thick layer of cartilage at the MCP joint without joint space narrowing at final follow up (Figure 9(B)).
Case 2. (A and B) The motion arc was 30  at final follow up.
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The patient returned to his work (civil engineer) and normal daily activity at 6 months postoperatively (Figure 10).