3D-Printed Metacarpal Prosthesis in the Treatment of Primary Osteosarcoma of the First Metacarpal: A Novel Surgical Technique

Abstract

Objective: Osteosarcoma at the first metacarpal is extremely rare. Reconstructing the metacarpal after tumor resection is essential, as the thumb accounts for approximately 40%–50% of hand function. Although autografts, arthroplasty, and transposition have been reported as reconstruction options, their use is limited by complications such as secondary injury, nonunion, and displacement. In this study, we present a case of a patient with first metacarpal osteosarcoma who underwent tumor resection followed by reconstruction with a 3D-printed metacarpal prosthesis. We tend to introduce a novel strategy to reconstruct the first metacarpal and restore the hand function.

Methods: A 30-year-old male with 5-month history of first metacarpal swelling in the left hand was admitted to our center. Imaging examinations and incision biopsy confirmed a diagnosis of intramedullary well-differentiated osteosarcoma. A 3D-printed metacarpal prosthesis was then designed to achieve carpometacarpal (CMC) joint fusion and thumb metacarpophalangeal (MCP) joint reconstruction. Postoperative evaluations included X-ray and tomosynthesis-shimadzu metal artifact reduction technology (T-SMART) imaging to assess bone-prosthesis integration. Hand function was measured using the Musculoskeletal Tumor Society (MSTS) score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score.

Results: The tumor was completely resected, and a 3D-printed metacarpal prosthesis was performed to reconstruct the tumor defect. Postoperative imaging showed that the interface between bone and prosthesis was integrated and that there was no loose, displacement, or fracture of the implant. At the last follow-up, the patient had an MSTS score of 25/30 and a DASH score of 8/100. The range of motion on thumb MCP joint was 30° of flexion and 0° of extension. The Kapandji thumb opposition score was 4 points. The grip strength was 9 kg (compared to 30 kg on the contralateral side) and the key-pinch strength was 3 kg (compared to 8 kg on the contralateral side).

Conclusion: 3D-printed metacarpal prosthesis could be an effective reconstruction option for patients with low-grade malignant tumors. Themulti-planar fixation achieved through 3D surgical planning helps maintain thumb function and restore overall hand function.

Keywords

metacarpal / osteosarcoma / surgical technique / three-dimensional (3D)-printed prosthesis

References

[1] M. Henderson, M. W. Neumeister, and R. A. Bueno, Jr., “Hand Tumors: II. Benign and Malignant Bone Tumors of the Hand,” Plastic and Reconstructive Surgery 133, no. 6 (2014): 814e–821e,

[2] W. Daecke, S. Bielack, A. K. Martini, et al., “Osteosarcoma of the Hand and Forearm: Experience of the Cooperative Osteosarcoma Study Group,” Annals of Surgical Oncology 12, no. 4 (2005): 322–331,

[3] M. E. Puhaindran and E. A. Athanasian, “Malignant and Metastatic Tumors of the Hand,” Journal of Hand Surgery 35, no. 11 (2010): 1895–1900; quiz 1900,

[4] W. A. Ebeid, I. T. Badr, M. K. Mesregah, and B. Z. Hasan, “Outcome of Surgical Resection of Primary Malignant and Aggressive Benign Metacarpal Bone Tumors,” Orthopedics 44, no. 5 (2021): e633–e638,

[5] W. Daecke, S. Ahrens, H. Juergens, et al., “Ewing’s Sarcoma and Primitive Neuroectodermal Tumor of Hand and Forearm. Experience of the Cooperative Ewing’s Sarcoma Study Group,” Journal of Cancer Research and Clinical Oncology 131, no. 4 (2005): 219–225,

[6] L. R Ramos-Pascua, O. Fernández-Hernández, S. Sánchez Herráez, J. Santos Sánchez, and C. T. Flores, “Ewing Sarcoma of the First Metacarpal With a 9-Year Follow-Up: Case Report,” Journal of Hand Surgery 38, no. 8 (2013): 1575–1578,

[7] A. El Ghoneimy, I. Zaky, M. Zamzam, A. Kamel, N. Mounir, and N. El Kenaey, “Wide Resection of Primary Malignant Bone Tumors of the Hand in Children and Reconstruction Using Nonvascularized Fibular Bone Graft: Case Series and Literature Review,” Journal of Hand Surgery 47, no. 10 (2022): 1017.e1–1017.e7,

[8] K. B. Jones, J. A. Buckwalter, and E. F. McCarthy, “Parosteal Osteosarcoma of the Thumb Metacarpal: A Case Report,” Iowa Orthopaedic Journal 26 (2006): 134–137.

[9] A. J. Hills, S. Tay, and D. Gateley, “Chondrosarcoma of the Head of the Fifth Metacarpal Treated With an Iliac Crest Bone Graft and Concurrent Swanson’s Arthroplasty,” Journal of Plastic, Reconstructive & Aesthetic Surgery 67, no. 3 (2014): e84–e87,

[10] K. Muramatsu, K. Ihara, K. Doi, T. Hashimoto, S. Seto, and T. Taguchi, “Primary Reconstruction With Digital Ray Transposition After Resection of Malignant Tumor,” Archives of Orthopaedic and Trauma Surgery 128, no. 10 (2008): 1017–1021,

[11] T. M. Muir, T. P. Lehman, and W. H. Meyer, “Periosteal Osteosarcoma in the Hand of a Pediatric Patient: A Case Report,” Journal of Hand Surgery 33, no. 2 (2008): 266–268,

[12] N. F. Jones, B. P. Dickinson, and S. L. Hansen, “Reconstruction of an Entire Metacarpal and Metacarpophalangeal Joint Using a Fibular Osteocutaneous Free Flap and Silicone Arthroplasty,” Journal of Hand Surgery 37, no. 2 (2012): 310–315,

[13] I. Sahan, L. A. Blatt, J. De Deken, K. Anagnostakos, and C. Meyer, “Reconstruction of the First Metacarpal Bone With an Autologous Non-vascularized Fibular Graft After Enchondroma Resection,” Hand Surgery & Rehabilitation 40, no. 5 (2021): 698–701,

[14] O. Ishida, Y. Taniguchi, T. Sunagawa, O. Suzuki, and M. Ochi, “Pollicization of the Index Finger for Traumatic Thumb Amputation,” Plastic and Reconstructive Surgery 117, no. 3 (2006): 909–914,

[15] C. Bregoli, C. A. Biffi, K. Morellato, et al., “Osseointegrated Metallic Implants for Finger Amputees: A Review of the Literature,” Orthopaedic Surgery 14, no. 6 (2022): 1019–1033,

[16] T. Kuroiwa, K. Fujita, A. Nimura, T. Miyamoto, T. Sasaki, and A. Okawa, “A New Method of Measuring the Thumb Pronation and Palmar Abduction Angles During Opposition Movement Using a Three-Axis Gyroscope,” Journal of Orthopaedic Surgery and Research 13, no. 1 (2018): 288,

[17] T. Gong, M. Lu, Y. Wang, et al., “Is 3D-Printed Self-Stabilizing Endoprosthesis Reconstruction Without Supplemental Fixation Following Total Sacrectomy a Viable Approach for Sacral Tumours?,” European Spine Journal 33 (2024): 4316–4324,

[18] X. He, M. Lu, C. Zou, et al., “Three-Dimensional Printed Custom-Made Modular Talus Prosthesis in Patients With Talus Malignant Tumor Resection,” Journal of Orthopaedic Surgery and Research 19, no. 1 (2024): 273,

[19] T. Gong, M. Lu, J. Wang, et al., “3D-Printed Modular Endoprosthesis Reconstruction Following Total Calcanectomy in Calcaneal Malignancy,” Foot & Ankle International 44, no. 10 (2023): 1021–1029,

[20] J. Wang, L. Min, M. Lu, et al., “What Are the Complications of Three-Dimensionally Printed, Custom-Made, Integrative Hemipelvic Endoprostheses in Patients With Primary Malignancies Involving the Acetabulum, and What Is the Function of These Patients?,” Clinical Orthopaedics and Related Research 478, no. 11 (2020): 2487–2501,

[21] X. Shao, H. Ding, J. Li, et al., “Primary Cooperative Application of a LARS^® Tube and 3D-Printed Prosthesis for Reconstruction of the Distal Radius After En Bloc Resection of Giant Cell Tumor of Bone: A Comparative Retrospective Study,” Orthopaedic Surgery 15, no. 6 (2023): 1521–1533,

[22] T. Punyaratabandhu, B. Lohwongwatana, C. Puncreobutr, A. Kosiyatrakul, P. Veerapan, and S. Luenam, “A Patient-Matched Entire First Metacarpal Prosthesis in Treatment of Giant Cell Tumor of Bone,” Case Reports in Orthopedics 2017 (2017): 4101346,

[23] K. Okada, L. E. Wold, J. W. Beabout, and T. C. Shives, “Osteosarcoma of the Hand. A Clinicopathologic Study of 12 Cases,” Cancer 72, no. 3 (1993): 719–725,

[24] Y. Chen, S. Cheng, C. Zhao, and Y. Qian, “Metacarpal Osteosarcoma With Chest Wall Metastasis: A Case Report,” Asian Journal of Surgery 46, no. 3 (2023): 1424–1425,

[25] T. Yu, Z. Cai, X. Chang, et al., “Research Progress of Nanomaterials in Chemotherapy of Osteosarcoma,” Orthopaedic Surgery 15, no. 9 (2023): 2244–2259,

[26] A. Miyake, H. Morioka, H. Yabe, et al., “A Case of Metacarpal Chondrosarcoma of the Thumb,” Archives of Orthopaedic and Trauma Surgery 126, no. 6 (2006): 406–410,

[27] E. A. Athanasian, A. T. Bishop, and P. C. Amadio, “Autogenous Fibular Graft and Silicone Implant Arthroplasty Following Resection of Giant Cell Tumor of the Metacarpal: A Report of Two Cases,” Journal of Hand Surgery 22, no. 3 (1997): 504–507,

[28] C. Hein, B. Watkins, and L. M. Zuckerman, “Thumb Reconstruction With Arthrodesis to the Second Metacarpal Following Sarcoma Excision,” Case Reports in Orthopedics 2016 (2016): 8061036,

[29] Y. Harder, U. Buechler, and E. Vögelin, “Primitive Neuroectodermal Tumor of the Thumb Metacarpal Bone: A Case Report and Literature Review,” Journal of Hand Surgery 28, no. 2 (2003): 346–352,

[30] L. Xu, H. Qin, Z. Cheng, et al., “3D-Printed Personalised Prostheses for Bone Defect Repair and Reconstruction Following Resection of Metacarpal Giant Cell Tumours,” Annals of Translational Medicine 9, no. 18 (2021): 1421,

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.