Radiological appearances following limb replantation: a report of 5 cases.
Plain radiographs of the limbs were reviewed after replantation procedures following traumatic amputation in 5 patients at the wrist (2), mid-forearm (2) and knee (1). Following upper limb replantation, rapid development of osteopaenia was initially noted in the juxta-articular regions and metaphyses of the tubular bones of the hand. These changes were followed by diaphyseal cortical bone loss with evidence of subperiosteal, intracortical and endosteal bone resorption. Juxta-articular erosions developed at the margins of the small joints in the hand in all cases. Gradual resolution of bone changes was noted in 3 of the 4 cases where follow-up exceeded 5 years. Following lower limb replantation, there was no evidence of bone loss; however, severe neuropathic joint disease developed within 18 months and progressed over the following 9 years. We suggest that the radiographic changes observed after upper limb replantation reflect regional hyperaemia secondary to neurovascular damage, whilst the changes in the lower limb reflect a similar process in a limb subjected to weight bearing.
Jackson
A
A
Department of Diagnostic Radiology, Medical School, University of Manchester, UK.
Reilly
M
M
Watson
S
S
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D000843:Ankle Joint / Q000000981:diagnostic imaging; D000844:Ankylosis / Q000000981:diagnostic imaging; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging; D016723:Bone Remodeling; D005260:Female; D005542:Forearm / Q000000981:diagnostic imaging*; D005543:Forearm Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging; D007593:Joint Instability / Q000000981:diagnostic imaging; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging*; D008297:Male; D010026:Osteosclerosis / Q000000981:diagnostic imaging; D011859:Radiography; D012092:Replantation; D014953:Wrist / Q000000981:diagnostic imaging*; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery*