Background: Severe traumatic metacarpophalangeal joint (MCPJ) injuries with combined osteochondral, ligamentous and tendon injury present a complex reconstructive challenge, particularly in high demand occupations where preservation of motion is critical. This study reports the use of an autologous rib osteochondral graft for partial MCPJ reconstruction and reviews outcomes of available reconstructive options. Methods: A literature review was performed examining reconstructive options for traumatic MCPJ articular loss, including acute implant arthroplasty, osteochondral reconstruction and vascularised toe joint transfer. We then present the case of a 56-year-old RHD cabinet maker with a contaminated open dislocation of the right index finger MCPJ with complete extensor tendon and collateral ligament disruption and a large metacarpal head osteochondral defect (18×15×4mm). Following staged debridement, reconstruction was performed using a osteochondral rib autograft combined with extensor and collateral ligament repair and structured postoperative hand therapy. Results: Reported outcomes for traumatic MCPJ reconstruction are variable. Acute silicone MCPJ arthroplasty demonstrated mean arcs of motion of approximately 60°, while acute pyrocarbon arthroplasty achieved mean motion of 56°, frequently requiring secondary tenolysis (1, 2). Vascularised toe joint transfer offers biological resurfacing with reported MCPJ motion up to 69% of normal, but with donor-site morbidity (3). Costal cartilage reconstruction has demonstrated stable joints with lower motion but minimal donor-site morbidity (4). In our case, at 4 months the MCPJ was stable with active motion 0-70°, grip strength of 22kg versus 40kg contralaterally, no resting pain and minimal donor-site morbidity. Conclusion: Autologous rib osteochondral grafting for partial MCPJ defects is a viable, joint-preserving option for selected post-traumatic MCPJ defects, offering restoration of stability and motion while avoiding implant-related complications and significant donor site morbidity.