Short term efficacy on 3D printing assisted reconstruction of traumatic digit joint defects using rib and costoosteochondral autograft
Objective To explore the short-term efficacy on 3D printing assisted reconstruction of traumat-ic digit joint defects using rib and costo-osteochondral autograft.Methods From August 2022 to July 2023,7 patients with open digit joint defects had undergone emergency primary debridement and fracture fixation in the Department of Orthopaedics,988th Hospital of the Joint Logistics Support Force of PLA.Patients with more pha-langeal defects that could not be aligned were treated with antibiotic bone cement filling in the emergency surgery.In the second stage surgery,bone cement was removed and transfer of rib cartilage graft was performed to recon-struct the digit joint defect.According to a 1∶1 3D printed hand templates,rib cartilage grafts were crafted to the shape of digit joints,and then spliced together the digit joints and bone defects for fixation.Follow-up X-ray exami-nations were taken and assessment of the healing status of rib and fractures of phalangeal and metacarpophalangeal bones were carried out according to the Paley fracture healing score.At the outpatient follow-up,assessment of transferred joint movement and evaluation of upper limb function were conducted according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Visual Analogue Scale(VAS)pain scores were evaluated from the affected digits and donor sites.Results After reconstructive surgery,all 7 patients had primary healing of the wounds of hand.One patient had fat liquefaction at the donor site,and the rest had primary donor site healing.One patient received further surgery for extensor tendon repair after rib cartilage grafting due to the digital extensor tendon injury.All 7 patients were included in postoperative follow-up for 6-11 months,with an average of 9 months.All patients had excellent fracture healing according to the Paley fracture healing score.At the final follow-up,the extension and flexion of the digit joints were found at 40°-80°(average 56.2°)for proximal interphalangeal joints(4 patients),and 10° in extension and 85° in flexion for metacar-pophalangeal joint(1 patient).The range of motion of the thumb interphalangeal joint(2 patients)was 20°-35°(average 27.5°).Hand function was assessed according to Evaluation Trial Standards of Upper Limb Partial Func-tional of Hand Surgery of Chinese Medical Association and it was found that 3 patients were in excellent,3 in good and 1 in fair.Conclusion This study focused on the treatment of traumatic digit joint defects by transfer of indi-vidually crafted rib cartilages in reconstruction of the defected digit joint.It significantly improves the appearance and function of the defected digit joints,especially suitable for the irregular defects of phalangeal bones.
Rib and costoosteochondral transferDigit jointsOpen joint injuryCartilage injuryJoint defectAutograft
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