The Journal of HAND SURGERY
Golz et al.
5. Derkash RS, Niebauer JJ, Lane CS. Long-term followup of metacarpophalangeal arthroplasty with silicone dacron prosthesis. J HAND SURG 1986;l lA:5.53-8. 6. Swanson AB. Flexible implant arthroplasty for arthritic finger joints. J Bone Joint Surg 1972;54A:435-55. 7. Vahvanen V, Viljakka T. Silicone-rubber implant arthroplasty of the metacarpophalangeal joint in rheumatoid arthritis: a follow-up of thirty-two patients. J HANDSURG 1986;l lA:333-9. 8. Beckenbaugh RD, Dobyns JH, Linscheid RL, Bryan RS. Review and analysis of silicone-rubber metacarpophalangeal implants. J Bone Joint Surg 1976;58A:483-7.
9. Groff GD, Schned AR, Taylor TH. Silicone induced adenopathy eight years after metacarpophalangeal arthroplasty. Arthritis Rheum 198 1;24:1578-8 1. 10. Jensen CM, Boeckstyns MEH, Kristiansen B. Silastic arthroplasty in rheumatoid metacarpophalangeal joints. Acta Orthop Stand 1986;57:138-40. 11. Millender LH, Nalebuff EA, Hawkins RB, Ennis R. Infection after silicone prosthetic arthroplasty in the hand. J Bone Joint Surg 1975;57A:825-9. 12. Terranova W, Morgan RF. Late rupture of the flexor tendons as a complication of replacement arthroplasty. J HANDSURG 1987;12A:l5-17.
Segmental metacarpal replacement with bone cement and a silicone joint prosthesis: A case report The replacement
of the distal half of the third metacarpal
and the metacarpophalangeal
joint
with bone cement and a silicone implant is reported. Eight years after surgery, x-ray and clinical examination revealed no evidence of instability or material failure. The active and passive range of motion in the reconstructed
metacarpophalangeal
joint was 35 degrees, and the hand was free
of pain. (J HAND SURG 1992;17A:152-4.)
G. Lindstrijm,
MD,
PhD,
and A. Nystrijm,
Ray amputation
(i.e., a finger amputation involving the entire metacarpal or with preservation of only its base) is a time-proven and often rewarding
From the Departmentof Hand Surgery, University of Umea Hospital, Umei,
Sweden.
Received for publication April 24, 1991.
Aug.
14, 1990; accepted
in revised form
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: .ke Nystrom, MD, PhD, Department of Hand Surgery, University of UmeH Hospital, S-901 85, UmeH, Sweden. 3/l/31033
152
THEJOURNAL OF HANDSURGERY
MD,
PhD,
UmeH, Sweden
technique when function cannot be restored to an injured finger. The cosmetic result is generally acceptable, but the inevitable loss of palmar width may impair the function of the hand. ’ Therefore ray amputation may not be the wisest choice in the case of a functional finger that has lost its metacarpal support. Among the available methods for restoring mobility, noncemented prosthetic devices are probably the most frequently used. Silicone (Silastic) implants for replacement of the metacarpophalangeal (MP) joint can provide satisfactory long-term functional results.2. 3 It is generally considered that silicone joint replacements can be used only if a solid circumferential bone support can be provided to both stems of the prosthesis. The present case demonstrates a method that makes it pos-
Vol. l7A. No. 1 January I992
Fig. I. Preoperative x-ray film showing giant cell tumor, which involves the distal half of the third metacarpal.
Segmental
metacarpal
replacement
153
Fig. 2. X-ray film taken 8 years after surgery. There is no radiographic evidence of material failure or loosening.
sible to use a silicone MP implant also after resection of the distal half of a metacarpal bone. Case report A healthy 47-year-old high school teacher was referred for treatment of a symptomatic swelling of the right third MP joint. The preoperative investigation. which included x-ray, bone scan. and microscopic examination of tissue samples. demonstrated a giant cell tumor occupying the distal third of the third metacarpal (Fig. I ). Because the tumorous growth involved the entire circumference of the bone, the entire distal half of the metacarpal was removed. With a silicone sheath to protect surrounding tissues, the excised bone was replaced with bone cement (Palaces, Schering Co., Kenilworth, N.J.). The joint was immediately reconstructed with a No. 7 Swanson digital prosthesis. The postoperative period was uneventful, and the patient
was started on a regular reconstructed hand therapy program. At 8-year follow-up, the active range of motion in the reconstructed MP joint was 35 degrees (35 to 70 degrees), with no sign of dislocation of the prosthesis or of the cemented bone replacement ( Figs. 2 and 3). The hand was free of pain. and the patient said that she had no functional impairment that required further treatment.
Discussion Restoration of a metacarpal segment with bone cement will work only in selected cases. A number of factors, such as the patient’s age, profession, or leisure activities, must be considered to minimize the risk of failure. It might therefore be preferable to consider more sophisticated reconstructive techniques in many
The Journal of HAND SURGERY
Lindstriim and Nystrtim
situations in which the preservation of a finger with a mobile MP joint is desired.4. 5 In cases such as the one presented here, the combination of bone cement and a silicone joint implant may be a satisfactory alternative to a ray amputation. The technique is safe and simple, and the implanted material is an excellent tissue spacer. The combination of bone cement and silicone might therefore be considered as a temporary solution when a definite reconstruction is desired but cannot be performed at the time of the primary surgery. REFERENCES 1.
2.
3. 4. 5. Fig. 3. Photograph taken 8 years after surgery. There is no
Posner MA. Ray transposition for central digital loss. J HAND SURG 1979;4:242-57. Hagert CG. Implants designed for finger joints: a roentgenographic study and a study of implant wear and tear; an experimental study. Stand J Plast Reconstr Surg 1975;9:53-63. Hagert CG. Advances in hand surgery: finger joint implants. Surg Annu 1978;10:253-75. Menon J. Reconstruction of the metacarpophalangeal joint with autogenous metatarsal. J HAND SURG 1983;8:443-6. Tsai T-M, Jupiter JB, Kutz JE, Kleinert HE. Vascularized autogenous whole joint transfer in the hand: A clinical study. J HAND SURG 1982;7:335-42.
perceivable skin reaction to the underlying bone cement.
Heterotopic para-articular ossification of the proximal interphalangeal joint A 24-year-old woman sustained a closed head injury. She regained consciousness over a 2-month period hut heterotopic ossification developed around both elbows and the proximal interphalangeal joints of her left ring and long fingers. The new hone was allowed to mature and was subsequently
resected from both elbows and the fingers with substantial
improvement
in func-
tion. There is no clear explanation for the formation of such heterotopic bone. (J HAND SURC 1992;17k154-7.)
Marc Asselmeier,
MD, and Terry R. Light, MD, Maywood, Ill.
From the Department of Orthopaedic Surgery and Rehabilitation, Loyola University School of Medicine, Maywood. Ill. Received for publication June 5, 1990.
March 24, 1989; accepted
in revised form
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Terry R. Light, MD, Department of Orthopaedic Surgery and Rehabilitation, Loyola University School of Medicine, 2160 S. First Ave., Maywood, IL 60153. 311123619
154
THE JOURNAL OF HAND SURGERY
C
alcification in peri-articular and paraarticular locations may occur in association with tumoral calcinosis, psuedogout, trauma, and renal failure. True heterotopic new bone formation is seen less commonly and may occur in association with conditions such as spinal cord injury and coma,’ as well as bums.2 The hip, knee, shoulder, and elbow are the most common sites of involvement. We describe a case report of heterotopic ossification involving the fingers after a closed head injury.
Golz et al.
5. Derkash RS, Niebauer JJ, Lane CS. Long-term followup of metacarpophalangeal arthroplasty with silicone dacron prosthesis. J HAND SURG 1986;l lA:5.53-8. 6. Swanson AB. Flexible implant arthroplasty for arthritic finger joints. J Bone Joint Surg 1972;54A:435-55. 7. Vahvanen V, Viljakka T. Silicone-rubber implant arthroplasty of the metacarpophalangeal joint in rheumatoid arthritis: a follow-up of thirty-two patients. J HANDSURG 1986;l lA:333-9. 8. Beckenbaugh RD, Dobyns JH, Linscheid RL, Bryan RS. Review and analysis of silicone-rubber metacarpophalangeal implants. J Bone Joint Surg 1976;58A:483-7.
9. Groff GD, Schned AR, Taylor TH. Silicone induced adenopathy eight years after metacarpophalangeal arthroplasty. Arthritis Rheum 198 1;24:1578-8 1. 10. Jensen CM, Boeckstyns MEH, Kristiansen B. Silastic arthroplasty in rheumatoid metacarpophalangeal joints. Acta Orthop Stand 1986;57:138-40. 11. Millender LH, Nalebuff EA, Hawkins RB, Ennis R. Infection after silicone prosthetic arthroplasty in the hand. J Bone Joint Surg 1975;57A:825-9. 12. Terranova W, Morgan RF. Late rupture of the flexor tendons as a complication of replacement arthroplasty. J HANDSURG 1987;12A:l5-17.
Segmental metacarpal replacement with bone cement and a silicone joint prosthesis: A case report The replacement
of the distal half of the third metacarpal
and the metacarpophalangeal
joint
with bone cement and a silicone implant is reported. Eight years after surgery, x-ray and clinical examination revealed no evidence of instability or material failure. The active and passive range of motion in the reconstructed
metacarpophalangeal
joint was 35 degrees, and the hand was free
of pain. (J HAND SURG 1992;17A:152-4.)
G. Lindstrijm,
MD,
PhD,
and A. Nystrijm,
Ray amputation
(i.e., a finger amputation involving the entire metacarpal or with preservation of only its base) is a time-proven and often rewarding
From the Departmentof Hand Surgery, University of Umea Hospital, Umei,
Sweden.
Received for publication April 24, 1991.
Aug.
14, 1990; accepted
in revised form
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: .ke Nystrom, MD, PhD, Department of Hand Surgery, University of UmeH Hospital, S-901 85, UmeH, Sweden. 3/l/31033
152
THEJOURNAL OF HANDSURGERY
MD,
PhD,
UmeH, Sweden
technique when function cannot be restored to an injured finger. The cosmetic result is generally acceptable, but the inevitable loss of palmar width may impair the function of the hand. ’ Therefore ray amputation may not be the wisest choice in the case of a functional finger that has lost its metacarpal support. Among the available methods for restoring mobility, noncemented prosthetic devices are probably the most frequently used. Silicone (Silastic) implants for replacement of the metacarpophalangeal (MP) joint can provide satisfactory long-term functional results.2. 3 It is generally considered that silicone joint replacements can be used only if a solid circumferential bone support can be provided to both stems of the prosthesis. The present case demonstrates a method that makes it pos-
Vol. l7A. No. 1 January I992
Fig. I. Preoperative x-ray film showing giant cell tumor, which involves the distal half of the third metacarpal.
Segmental
metacarpal
replacement
153
Fig. 2. X-ray film taken 8 years after surgery. There is no radiographic evidence of material failure or loosening.
sible to use a silicone MP implant also after resection of the distal half of a metacarpal bone. Case report A healthy 47-year-old high school teacher was referred for treatment of a symptomatic swelling of the right third MP joint. The preoperative investigation. which included x-ray, bone scan. and microscopic examination of tissue samples. demonstrated a giant cell tumor occupying the distal third of the third metacarpal (Fig. I ). Because the tumorous growth involved the entire circumference of the bone, the entire distal half of the metacarpal was removed. With a silicone sheath to protect surrounding tissues, the excised bone was replaced with bone cement (Palaces, Schering Co., Kenilworth, N.J.). The joint was immediately reconstructed with a No. 7 Swanson digital prosthesis. The postoperative period was uneventful, and the patient
was started on a regular reconstructed hand therapy program. At 8-year follow-up, the active range of motion in the reconstructed MP joint was 35 degrees (35 to 70 degrees), with no sign of dislocation of the prosthesis or of the cemented bone replacement ( Figs. 2 and 3). The hand was free of pain. and the patient said that she had no functional impairment that required further treatment.
Discussion Restoration of a metacarpal segment with bone cement will work only in selected cases. A number of factors, such as the patient’s age, profession, or leisure activities, must be considered to minimize the risk of failure. It might therefore be preferable to consider more sophisticated reconstructive techniques in many
The Journal of HAND SURGERY
Lindstriim and Nystrtim
situations in which the preservation of a finger with a mobile MP joint is desired.4. 5 In cases such as the one presented here, the combination of bone cement and a silicone joint implant may be a satisfactory alternative to a ray amputation. The technique is safe and simple, and the implanted material is an excellent tissue spacer. The combination of bone cement and silicone might therefore be considered as a temporary solution when a definite reconstruction is desired but cannot be performed at the time of the primary surgery. REFERENCES 1.
2.
3. 4. 5. Fig. 3. Photograph taken 8 years after surgery. There is no
Posner MA. Ray transposition for central digital loss. J HAND SURG 1979;4:242-57. Hagert CG. Implants designed for finger joints: a roentgenographic study and a study of implant wear and tear; an experimental study. Stand J Plast Reconstr Surg 1975;9:53-63. Hagert CG. Advances in hand surgery: finger joint implants. Surg Annu 1978;10:253-75. Menon J. Reconstruction of the metacarpophalangeal joint with autogenous metatarsal. J HAND SURG 1983;8:443-6. Tsai T-M, Jupiter JB, Kutz JE, Kleinert HE. Vascularized autogenous whole joint transfer in the hand: A clinical study. J HAND SURG 1982;7:335-42.
perceivable skin reaction to the underlying bone cement.
Heterotopic para-articular ossification of the proximal interphalangeal joint A 24-year-old woman sustained a closed head injury. She regained consciousness over a 2-month period hut heterotopic ossification developed around both elbows and the proximal interphalangeal joints of her left ring and long fingers. The new hone was allowed to mature and was subsequently
resected from both elbows and the fingers with substantial
improvement
in func-
tion. There is no clear explanation for the formation of such heterotopic bone. (J HAND SURC 1992;17k154-7.)
Marc Asselmeier,
MD, and Terry R. Light, MD, Maywood, Ill.
From the Department of Orthopaedic Surgery and Rehabilitation, Loyola University School of Medicine, Maywood. Ill. Received for publication June 5, 1990.
March 24, 1989; accepted
in revised form
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Reprint requests: Terry R. Light, MD, Department of Orthopaedic Surgery and Rehabilitation, Loyola University School of Medicine, 2160 S. First Ave., Maywood, IL 60153. 311123619
154
THE JOURNAL OF HAND SURGERY
C
alcification in peri-articular and paraarticular locations may occur in association with tumoral calcinosis, psuedogout, trauma, and renal failure. True heterotopic new bone formation is seen less commonly and may occur in association with conditions such as spinal cord injury and coma,’ as well as bums.2 The hip, knee, shoulder, and elbow are the most common sites of involvement. We describe a case report of heterotopic ossification involving the fingers after a closed head injury.
