Clinical considerations

Scrutiny of one's own hand in varying stages of grasp reveals that the position of the MP joint at the extreme of making a fist becomes more flexed moving from index to small. Index and long MP

joints assume less of a flexion posture than ring and small, and for most types of prehension that require either key or chuck pinch, the radial MP joints flex no more than 30° or so (Fig. 1).

In terms of grasping a cylindrical object, only those with extremely small circumferences require any of the finger MP joints to flex more than this amount (see Fig. 1). And, as was highlighted above, despite the modest flexion required at the

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Fig. 2. Tupper arthroplasty, in which the distally based volar plate is used for resurfacing. (From Flatt AE. Care of the arthritic hand. 4th edition. Philadelphia: Mosby; 1983; with permission.)
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Fig. 3. (A) Horizontal mattress suture is preplaced through drill holes in the metacarpal. (B) The suture is tied down and the graft conforms to the shape of the metacarpal. (From Netscher D, Eladoumikdachi F, Gao YH. Resurfacing arthroplasty for metacarpopha-langeal joint osteoarthritis: a good option using either perichondrium or extensor retinaculum. Plast Reconstr Surg 2000;106:1430-3; with permission.)

Fig. 3. (A) Horizontal mattress suture is preplaced through drill holes in the metacarpal. (B) The suture is tied down and the graft conforms to the shape of the metacarpal. (From Netscher D, Eladoumikdachi F, Gao YH. Resurfacing arthroplasty for metacarpopha-langeal joint osteoarthritis: a good option using either perichondrium or extensor retinaculum. Plast Reconstr Surg 2000;106:1430-3; with permission.)

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Fig. 4. Resection arthroplasty case example: (A)Preoperativeposteroanterior(PA)radiographshowsMPjointarthrosis. (B) Preoperative photograph of the dorsum of the hand. (C) Preoperative flexion. (D) Intraoperative photograph of the resected MP j oint. (E) Intraoperative photograph of the harvested extensor retinaculum. (F) Postoperative PA radiograph 6 months following surgery. (G) Flexion 6 months after resection arthroplasty. (H) Extension 6 months after resection arthroplasty.

Fig. 4. Resection arthroplasty case example: (A)Preoperativeposteroanterior(PA)radiographshowsMPjointarthrosis. (B) Preoperative photograph of the dorsum of the hand. (C) Preoperative flexion. (D) Intraoperative photograph of the resected MP j oint. (E) Intraoperative photograph of the harvested extensor retinaculum. (F) Postoperative PA radiograph 6 months following surgery. (G) Flexion 6 months after resection arthroplasty. (H) Extension 6 months after resection arthroplasty.

MP joint for most grasping activities, stability is essential to empower, if you will, the rest of the finger, particularly the PIP joint.

Arthrosis of the finger MP joints is not uncommon, and is usually secondary to inflammatory arthritis. In general, such problems are commonly amenable to implant arthroplasty; however, in the setting of postinfectious arthrosis or following trauma, in which soft-tissue restraints or bone are absent, alternative reconstructive techniques must

Fig. 4 (continued)

be used. Resection arthroplasty and arthrodesis may provide valuable salvage.

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