A 26-year-old woman with a giant cell tumor of the metacarpal bone of the index finger was treated by en bloc resection and metacarpal reconstruction. A free autogenous iliac crest bone graft was used to reconstruct the metacarpal and a free autogenous costal cartilage graft was used to resurface the metacarpophalangeal joint. The bone graft was transfixed with a plate. The patient developed 12 degrees-62 degrees motion at the metacarpophalangeal joint and has maintained a stable joint space for 30 months. Viable hyaline cartilage was present when a biopsy procedure was performed on the joint at five months. The bone graft rapidly incorporated. There has been no evidence of tumor recurrence.