Article

Reconstruction post-traumatique des articulations digitales par greffe de cartilage costal -
In digital joint defects, reconstruction is meant to obtain a stable, mobile and
pain-free finger. Six patients aged 29 years in average and who were
prospectively followed-up presented with digital joint defects that affected at
least half of either the proximal interphalangeal (PIP) joint or the
metacarpophalangeal (MCP) joint. These defects were treated in emergency (four
cases) or scheduled for an autograft of costal cartilage harvested from the ninth
rib. Four digits showed lesions of the extensor system which were repaired. One
digit grafted after complete amputation was no more vascularized. All patients
were reviewed and prospectively followed-up by the surgeons and were also
reviewed by an independent operator 16.1 months post-surgery in average .
No infection occurred. None of the grafted fingers had to undergo arthrodesis or
secondary amputation. One case of type 1 complex regional pain syndrome occurred.
No functional or aesthetic complaint was reported, and no complication was
observed at the donor site.
The mean arc of motion was 33 degrees for the
PIP joint and 37 degrees for the MCP joint. Mean total active motion
(TAM) was 191 degrees (160-250 degrees ), whichever the injured finger, i.e.
79.1% compared with the contralateral finger. The Buck-Gramko score averaged
11/15 . The Strickland score (interphalangeal TAM) was 57.8%, which
corresponds to a medium result. The quick DASH assessment averaged 17.42
(0-47.72). Even if arthrodesis or amputation remain the conventional option in
case of joint defect, prosthesis
or cartilage grafting constitute solutions that
allow the preservation of a functional painless finger.
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Langue : ANGLAIS