Poster Presentation New Zealand Association of Plastic Surgeons ASM & AGM

Retrospective radiological articular surface comparison: base of the middle phalanx second toe compared with base of middle phalanx of the fingers (1271)

Sam Hamilton 1 , James Leong 1
  1. Plastic and Reconstructive Surgery , Monash Health, Melbourne, VIC, Australia

Background

Phalangeal fracture are the most commonly fractured bone of the hand (1) and can result in poor outcomes such as stiffness, pain and loss of function (2). Complex intraarticular fractures involving the proximal interphalangeal joint (PIPJ) of the fingers may be managed by a hemi-hamate arthroplasty. However, Freiberg et al completed a radiological analysis comparing the hamate and PIPJ articular surfaces of fingers and found they are often inconsistent with the highest rate of articular consistency seen in the little finger with only 38.7% (3). We analyse another osteochondral graft donor site – the second toe middle phalanx base. 

 

Methods

All fine slice computer tomography (CT) images in patients who underwent both a CT of the second toe and fingers since May 2015 at Monash Health were reviewed retrospectively. This resulted in 7 patients being included in the study. Measurements of the articular surfaces of all index, middle, ring and little finger and second toe middle phalanx bases were taken by a single author for consistency.  

 

Results

All finger middle phalanx bases share radiological similarities with that of the second toe middle phalanx base. However, the little and index finger have the most in common out of all the digits analysed. 

 

Discussion / conclusion

The second toe middle phalanx base has and anatomically similar articular surface to that of the base of the middle phalanx of the fingers. As a result, it has the potential to provide an alternative donor site for an osteochondral graft to reconstruct the base of the middle phalanx in complex PIPJ fractures of the fingers. The index and little fingers sharing the most similarities with the second toe.

  1. 1. Anakwe R, Aitken S, Cowie J, Middleton S and Court-Brown C, 2010. The epidemiology of fractures of the hand and the influence of social deprivation. Journal of Hand Surgery (European Volume), 36(1), pp.62-65.
  2. 2. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med. 2008;1(2):97-102. doi:10.1007/s12178-007-9014-z
  3. 3. Calva D, Calotta N, Lopez J, Christopher A, Magid D, Demehri S and Lifchez S, 2015. A simple pre-operative imaging method to assess donor and recipient anatomy in hemi-hamate arthroplasty for proximal interphalangeal joint reconstruction. Surgical and Radiologic Anatomy, 38(6), pp.699-704.