Clinical Example: Pyrolytic carbon proximal interphalangeal joint implant arthroplasty

Small joint arthoplasty has been an ongoing problem of hand surgery.  The delicate and anatomically precise joints of the fingers function within a very narrow tolerance of friction and mechanical balance of bone and soft tissue forces. Historically, rigid (metal and plastic) implants have failed because the mechanical mismatch at the bone-implant interface has resulted in implant displacement due to reactive bone remodelling. Flexible (silicone rubber) implants have failed because of implant breakage, erosive reaction to implant wear debris, and inability of flexible implants to provide rotational and lateral stability. 

Pyrolytic carbon implant arthroplasty of the finger joints appears to be an improvement on previous strategies, as it mimics the normal joint mechanics, lack of wear debris and a close match to the mechanical characteristics of the finger bones.


 
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Pyrolytic carbon implants for proximal interphalangeal joints (above) and metacarpophalangeal joints (below).  Another proximal interphalangeal joint post traumatic reconstruction is shown here and an example of metacarpophalangeal joint implants is posted here.
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Middle phalanx base component on the left, proximal phalanx base component on the right, palmar articular views.
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lateral view.
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Palmar view.
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Dorsal view.
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This gentleman presented with stiffness and lateral deviation of the ring finger proximal interphalangeal joint following volar plate arthroplasty for dorsal fracture dislocation.

Preoperative and postoperative radiographs.

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