Intraoperative fracture of a pyrocarbon PIP total joint-a case report

Pain or dysfunction of the finger joints due to arthritis or traumatic injuries that fail medical management may necessitate arthroplasty or joint replacement. The goals of the finger joint implant arthroplasty are to relieve pain, to correct deformity, and to improve the function and appearance of the hand. Several prosthetic implants have been used for the replacement of the proximal interphalangeal (PIP) joint. Pyrocarbon materials, a form of pyrolytic carbon, a ceramic-like material, have proven to be strong, durable, resistant to wear and nonreactive in the body. The Ascension PIP pyrocarbon total joint is a bicondylar, anatomically shaped, articulating implant that allows joint flexion-extension, while providing some restriction of adduction-abduction motion. A review of the literature of pyrocarbon PIP prosthesis reveals little clinical data. The case of a 33-year-old man with posttraumatic arthritis proximal interphalangeal joint right long finger is reported. The case was treated surgically using the Ascension PIP total joint. During the insertion of the implant, the proximal component fractured at the sub-articular collar. The component was removed, and a new implant was inserted without complication. Critical evaluation revealed that there was an inadequate resection of the volar lip resulting in a stress riser on the implant during impaction. Careful attention to this technical point will hopefully minimize the occurrence of this complication as the availability and use of these implants increases.