To investigate the clinical effect of autologous joint transplantation in the repair of traumatic metacarpophalangeal joint defect.

From June 2007 to January 2020, 15 patients with traumatic metacarpophalangeal joint defect treated in the Department of Orthopedics and Traumatology of Shenzhen Integrated Traditional Chinese and Western Medicine Hospital were selected. Before the operation, the patient were completed various routine examinations, and performed direct digital X-ray photography system inspections of the affected hand and joint transplantation, improved the patient′s overall nutritional status and corrected the hypoproteinemia and anemia. Smoking was strictly prohibited during the perioperative period, and bed-sized and urinary training was performed before the operation; wound secretion culture was performed to eliminate wound infection in patients in the sub-emergency period; the joint to be transplanted was extended to a suitable joint transplantation space with an extension stent before the second-stage operation. During the operation, debridement of the affected area was carried out, hemostasis was performed, injury of the digital blood vessels and nerve of the extensor tendon of the bone joint and skin defect of the joint were investigated, and the length of the defect of the bone joint was measured. According to the injury situation of the patients, three methods were used to repair the injury: free transplantation of the second metatarsophalangeal joint, metacarpophalangeal joint transplantation of the abandoned finger and half joint transplantation of the metacarpophalangeal joint. After the operation, the patient stayed in bed absolutely for 1 week, absolutely non-smoking, and kept warm with heat preservation lamp; the patient was treated with anti-infection, anti-vasospasm, anti-coagulation, and systemic support. The stitches were removed 2 weeks after the operation, and rehabilitation training was gradually carried out. The X-ray was taken to check the bone healing on a regular basis, and the Kirschner wire was removed after the bone was healed. The blood flow of grafted joints and carried flaps and affected finger was observed 1 week after operation, and observed whether there was vascular crisis; the wound healing was observed 2 weeks after surgery; the bone healing condition of transplanted joint was observed 12 weeks after operation. The postoperative outpatient follow-up was 6 to 24 months to observe the recovery of the patient′s hand function.

All 15 cases of metacarpophalangeal joint defects were well repaired, the transplanted joints and skin flaps survived well, the blood supply of the repaired fingers was good and no vascular crisis occurred in the flaps and affected fingers, all wounds healed in grade A. The average postoperative follow-up was (14.5±4.6) months. There was continuous callus passing through the bone junction of the transplanted joint, bone healed, and there was no local tenderness, no longitudinal percussion pain, and no abnormal movement. The range of motion of the transplanted metacarpophalangeal joint: dorsal extension 0 to 10°, flexion 60° to 90° (average 75°). In the evaluation of hand function recovery, 10 cases were excellent and 5 cases were good, the excellent and good rate was 100%.

Autogenous joint transplantation for the repair of traumatic metacarpophalangeal joint injury can well restore the metacarpophalangeal joint function of the affected finger, preserve the integrity of the affected finger, and have a satisfactory effect.