PMC3535410_01
Photograph at the first consultation. a Displacement to the ulnar side is seen on extension. b The ROM of the PIP joint was restricted within 60  at flexion
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Fig1
At first consultation, there was swelling in the PIP joint of the right middle finger and displacement of that finger to the ulnar side at extension position (Fig. 1).
X-ray image before treatment. Posterior and anterior view show bone defect in the articular surface of the PIP joint of the middle phalanx and displacement of the middle finger to the ulnar side. Lateral view shows similar findings
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Fig2
X-ray image of the lateral view showed depressed articular surface of the PIP joint (Fig. 2).
CT images before treatment. a Axial image, b sagittal image, and c 3D image. A bony defect 5.0 x 6.5 x 2.0 mm in size was seen in the articular surface of the PIP joint of the middle phalanx
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Fig3
CT images showed a bony defect sized 5 x 6.5 x 2 mm in the articular surface of the PIP joint in the middle phalanx (Fig. 3).
Operative procedure. a PIP joint was exposed by a palmar incision. Osteochondral defect of approximately 5 mm in diameter is seen in the articular surface of the middle phalanx. b, c Oblique osteochondral plug of 4.5 mm in diameter was harvested from the knee. d The drilled recipient hole was made in the osteochondral lesion of the middle phalanx, and the osteochondral plug was inserted and press-fitted
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Fig4
A cartilage defect approximately 5 mm in diameter was seen in the articular surface of the middle phalanx, and a cartilage defect of 1 x 2 mm in size was seen in the palmar side of the articular surface of the proximal phalanx (Fig. 4). The osteochondral plug was obtained with an obliquely angled cartilage surface along the long axis to facilitate insertion in the recipient hole (Fig. 4c).
Photograph at 1 year after treatment. a Slight displacement of the PIP joint to the ulnar side remained. b The ROM of the PIP joint improved to 90  at flexion
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Fig5
Although slight displacement to the ulnar side remains in the PIP joint, instability is not noted, (Fig. 5).
Imaging findings at 1 year after treatment. a, b X-ray and CT images show bone union with no dislocation of the osteochondral plug. Although slight displacement of the finger to ulnar side remained, the ulnar displacement of the axis improved from preoperative 14  to postoperative 8 . c MR image shows well-maintained joint space by the cartilage
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Fig6
Also, MR images showed a well-maintained joint space by the transplanted cartilage (Fig. 6).