case_images: PMC11785535_01
case_images: Preoperative photograph of hands showing swelling in fourth metacarpal of the right hand.
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case_images: A 20-year-old female, with an unremarkable past medical and surgical history, presented to our clinic with a progressively increasing, painful swelling on the right-hand dorsum on the fourth distal MCP region (Fig. 1).
case_images: Oblique (left) and antero-posterior (right) view of the right hand revealing an expansile, lytic lesion with a soap bubble appearance over the entire fourth metacarpal bone with thinning of the cortex.
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case_images: A plain radiograph (Fig. 2 arrow) showed the hallmark expansile soap bubble lesion involving the entire distal fourth MCPJ approaching the articular surface of the MCP.
case_images: (A) GCT of the metacarpal. Note that the osteotomy of the proximal phalanx is visible in the picture. (B) Lesion excised. Both ends of the bone can be seen.
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case_images: The patient underwent en bloc resection of the tumor consisting of the fourth metacarpal, MCPJ and a portion of proximal phalanx by dorsal approach (Fig. 3A and B). An osteotomy of MCP was done at the level of the body ~3 cm proximal to the lesion (Fig. 3A).
case_images: Harvested second toe can be seen.
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case_images: A standard second toe harvest along with ~4 cm of the metatarsal bone was performed (Fig. 4).
case_images: (A) Intraoperative X-ray showing K-wire inserted through the interphalangeal joint crossing the bone flap reaching up to the second metacarpal and another K wire inserted through the interphalangeal joints. (B) After fixation.
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case_images: The metatarsal was fixed with the base of the metacarpal using Kirschner wire (K-wire) (Fig. 5A and B). A 1 deep vein was identified, and the other vein was anastomosed in the superficial venous system on the dorsum of the hand (Fig. 5A and B).
case_images: Post-operative X-ray at 3 weeks.
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case_images: Postoperative X-rays showed satisfactory healing at both bony unions (Fig. 6).
case_images: (A) Picture taken at 8 weeks postoperatively of the hand. (B) Picture taken at 8 weeks postoperatively of the donor site.
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case_images: There was also slight flexion deformity of the distal interphalangeal joint of the ring finger (Fig. 7).