CASE REPORT article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicAdvancing Orthopedic Surgery: unique Case Reports driving progressView all 7 articles
A case of functional reconstruction of second metacarpal following complex trauma with free fibula flap and silicone arthroplasty
Provisionally accepted
- Plastic Surgery Unit, Department of Neurosciences, University of Padua, Padua, Italy
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Complex metacarpal fractures with segmental bone loss and joint involvement pose significant challenges for the hand trauma surgeon. When traditional techniques are inadequate, microsurgical reconstruction and joint arthroplasty may offer a viable alternative. We report the case of a 32-year-old male who sustained a high-energy injury to the right hand, resulting in a comminuted fracture of the second metacarpal head and extensive dorsal soft tissue loss. After initial management, reconstruction of the second metacarpal was performed using a free osteocutaneous fibula flap. Although the vascularized bone graft was sculpted to settle in the metacarpophalangeal joint, mobility was not preserved. A staged silicone MCP arthroplasty then was later performed to improve joint mobility. At 18 months follow-up, the patient showed good soft tissue coverage, restored grip strength and proximal interphalangeal joint motion, but improvement in MCP range of motion remained partial despite arthroplasty. This article highlights the potential and limitations of combining vascularized bone transfer with prosthetic joint replacement in high-demand patients following trauma.
Keywords: Arthroplasty, bone transfer, Flap reconstruction, Free fibula, Hand Injuries, Hybrid Reconstruction, Implant, Metacarpal
Received: 27 Sep 2025; Accepted: 29 Nov 2025.
Copyright: © 2025 Brambullo, Caporali, Ricci, Vindigni and Bassetto. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tito Brambullo
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