PMC8046473_01
Clinical photograph of the patient at presentation.
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F1
On examination, there was an extension lag at the middle finger, poor grip strength, and reduced height of middle ray (Fig. 1).
Radiograph of the affected hand at the time of initial presentation.
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F2
The X-ray showed pathological fracture of third metacarpal with osteolytic lesion involving base of second metacarpal and carpal bones (Fig. 2).
Magnetic resonance imaging images of the hand.
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F3
It also showed pathological fracture involving capitate with patchy areas of osteolysis (Fig. 3).
Serial radiographs showing progressive osteolysis.
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F4
Serial X-rays taken at 4 weeks, 8 weeks, 12 weeks, 18 weeks, and 6 months revealed that there was progressive concentric reduction of metacarpal shaft, first involving third then fourth metacarpal giving appearance of a sucked candy (Fig. 4).
Immediate post-operative radiograph.
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F5
Non-vascularized fibular autologous graft was harvested from the ipsilateral limb and fixed with transverse k-wires to adjacent metacarpal (Fig. 5).
Radiograph at 2-year follow-up showing well incorporated of the fibular graft.
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F6
At the end of 2 years, graft was completely incorporated (Fig. 6) and the patient gained functional recovery (Fig. 7) with active flexion at metacarpophalangeal joints of the 3rd and 4th finger from 0 to 70  and normal range at proximal interphalangeal (PIP) joint (0-100 ) and DIP (0-80 ) joints.