Proximal phalanx condylar lesions are well known injuries. Total condylar defect, however, is an exceptional therapeutic challenge. We report the case of a 19-year-old male who sustained complex hand trauma following a circular saw accident, including a lesion that destroyed the entire lateral condyle of the middle finger's proximal phalanx. A custom-made non-vascularized composite graft taken from the second toe proved to be a viable option for reconstruction not only of the condyle but also of the lateral ligaments and part of the extensor system. At 1-year follow-up, results were very satisfactory, and the patient had resumed his work as a carpenter 6 months after surgery.
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