Introduction: Joint reconstruction following trauma at the proximal interphalangeal or metacarpophalangeal levels remain a difficult problem in hand surgery. Function of the injured finger depends on the mobility and stability at these joints. In fingers amputated at these levels with joint destruction, the hand surgeon can perform either an arthrodesis or a replacement arthroplasty (either as an emergency or as a secondary procedure). Arthrodesis will give a stable pain-free joint, but at the cost of sacrificing mobility and even cosmesis.Clinical Picture: We report a case of traumatic amputation through the proximal interphalangeal joint (PIPJ) of the right middle finger. Arthrodesis of the PIPJ in extension using Kirschner wires was performed following replantation due to extensive periarticular soft tissue loss, so as to enable repair and healing of the extensor mechanism. This results in poor cosmesis and stiffness of finger interfering with function three months after surgery. Treatment and Outcome: A prosthetic total joint replacement of PIPJ was performed as a secondary procedure. Satisfactory hand function and finger movement ensued two years after the procedure, with no loosening or infection of the implant. Conclusion: Total interphalangeal joint arthroplasty is a useful secondary procedure, after the initial replantation, for finger amputation with periarticular soft tissue loss.
A 41-year-old Chinese man had his dominant thumb, index and middle fingers caught by a wood-cutting machine while at work. He sustained a near-amputation of his middle finger through the proximal interphalangeal joint (PIPJ), with an intra-articular comminuted fracture of the head of the proximal phalanx (Fig. 1a) and the finger connected by only a radial strip of skin.
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