Osteochondral autograft from the second toe for complex proximal interphalangeal joint fracture-dislocations: a case report and literature review.

Abstract

Background: Managing complex fracture-dislocations of the proximal interphalangeal (PIP) joint poses significant clinical challenges, necessitating innovative treatment strategies.

Case description: This case report highlights the successful treatment of a severe PIP joint fracture-dislocation in a 49-year-old male carpenter who sustained a traumatic laceration to the right index finger. The injury's complexity led to the pioneering use of an osteochondral autograft from the patient's second toe proximal phalanx, marking a novel approach in autologous tissue utilization for joint reconstruction. This method effectively achieved fracture resolution and joint stabilization. A comprehensive literature search was conducted up to May 2024 across multiple databases, including PubMed, Embase, Cochrane Library, Scopus, and Web of Science. The search strategy employed a combination of Medical Subject Headings (MeSH) terms and keywords related to PIP joint fracture-dislocations and osteochondral autografts. Inclusion criteria were articles in English involving human subjects, focusing on osteochondral autografts for PIP joint fracture-dislocations. Exclusion criteria included studies involving animals or cadaveric models and those not focused on osteochondral grafts. Postoperative assessments of the patient revealed successful graft integration and notable recovery in finger mobility, alongside positive functional hand outcomes as confirmed by patient-reported measures.

Conclusions: The significant enhancements in structural and functional aspects highlight the potential of this technique. Despite its sparse representation in the literature, the favourable outcomes of this case strongly support further exploration of using second toe proximal phalanx osteochondral autografts. This report underscores the need for extensive, prospective research to comprehensively ascertain the method's effectiveness and safety in addressing intricate PIP joint fracture dislocations.