Dramatic functional and cosmetic improvement was achieved by phalangeal reconstruction and arthrodesis of the digital joints using iliac bone grafts in both hands of a fifty-nine-year-old woman with arthritis mutilans. Two years after the first bone graft there was no evidence of reabsorption except in the right ring finger where the graft had partially resorbed but rigidity was maintained by an intramedullary Kirschner wire. The rigidity of the fingers did not bother the patient.