We report an innovative approach to reconstructing the defect after excision of giant tumor cell (GCT) involving the entire first metacarpal. Reconstruction was performed using non-vascularized fibular autograft fused at the metacarpo-phalangeal (MP) joint and soft tissue arthroplasty using ligament reconstruction and tendon interposition (LRTI) at the carpo-metacarpal (CMC) joint of the thumb.

Two years after the procedure, the CMC joint had functional pain-free motion and radiographs showed fusion of the MP joint. The patient did not present with any major complication and was satisfied with the outcome of the procedure.

Human ; Female ; Young Adult ; Thumb ; Metacarpal Bones ; Autografts ; Metacarpophalangeal Joint ; Arthroplasty ; Tendons ; Finger Phalanges ; Ligaments ; Pain

BACKGROUND: Reconstruction for congenital hand anomalies, if indicated, is generally recommended during early childhood to optimize function before formal education starts and minimize the psychosocial impact. There have been limited reports on these conditions persisting beyond the recommended age for surgery. OBJECTIVE: The research aimed to explore the common reasons why patients consult for late surgery and determine the baseline function of the patients prior to reconstructive surgery using the Filipino Disability of Arm Shoulder and Hand (Fil-DASH). METHODS: An observational, chart review of cases from 2013-2021 was done. The reasons and indications were extracted from the history and Fil-DASH scores were recorded with available data. The results were presented using summary statistics and tabulation of qualitative data. RESULTS: Twenty-five hands in 20 patients underwent reconstruction of congenital anomalies persisting beyond childhood. The most common indication for surgery was concerns regarding work opportunities. Hope for a better function, cosmesis, social pressure and hygiene were the other reasons mentioned. Most of the patients did not complain of significant problems in doing activities of daily living. This was supported by their Fil-DASH scores and employment status prior to surgery. CONCLUSION In this population, the indications to request for reconstruction of congenital anomalies beyond childhood were not necessarily due to loss of function but to increase opportunities for employment, improved appearance and hope for increased function. The results may aid in the understanding of the natural history of congenital hand anomalies and guide the physicians with more specific advice for parents with children presenting with these conditions.