Reconstruction of Radio-Lunate Articulation With Grafts From Second Metatarsophalangeal Joint Using 3D Planning

Case: A 12-year-old girl with post-traumatic destruction of the radiolunate joint underwent CT-based three-dimensional (3D) planning with patient-specific guides/plate and a free, nonvascularized transfer of the second metatarsophalangeal joint: the proximal phalanx base resurfaced the lunate fossa and the second metatarsal head reconstructed the lunate using Osteochondral Autologous Transfer System. At 1 year, wrist pain resolved, near normal range of motion was achieved with a DASH score of 5. CT showed complete graft integration. Gait analysis showed no clinically relevant donor-site deficit. Conclusion: 3D-planned, osteochondral reconstruction of radiolunate articulation using grafts from the second metatarsophalangeal joint can preserve motion with minimal donor morbidity in skeletally immature patients. Level of Evidence: Case report, Level V .