title: Use of remodeled femoral head allograft for tarsal reconstruction in the treatment of müller-weiss disease.
abstract: Müller-Weiss disease (MWD), spontaneous avascular necrosis of the navicular in adults, is rare. Without treatment, it can result in permanent disability. Operative treatment is often required. MWD was suspected in a 51-year-old woman with spontaneous pain in her right foot. The radiologic tests showed a comma shaped deformed navicular and severe talonavicular necrosis and sclerosis. After excision of the necrotic navicular, a 5 × 5 × 3-cm defect appeared. A femoral head bone allograft was remodeled to fit this defect precisely. Autologous cancellous bone was also used. The allograft interposition arthrodesis was stabilized with a low contact plate. The histopathologic results showed avascular osteonecrosis, supporting the diagnosis of MWD. After 12 weeks of non-weight-bearing plaster cast immobilization, the radiographs showed consolidation and no osteolysis. At 6 months after surgery, she was fully weight-bearing. The low contact plate was removed, because it impeded exercise. After 10 months, she was walking pain free. At 14 months after surgery, her radiographs still showed good consolidation, with no sign of osteolysis. The use of a bone allograft to cover a tarsal defect could be a safe and effective operative treatment of MWD that has not yet been reported in English-language studies. This treatment also results in minimal donor site morbidity.
authors.affiliation: Department of Plastic, Reconstructive, and Hand Surgery, Medisch Spectrum Twente, Enschede, The Netherlands. anouktan@hotmail.com
authors.forename: Anouk
authors.initials: A
authors.lastname: Tan
authors.forename: Yvonne C M M
authors.initials: YC
authors.lastname: Smulders
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Zöphel
mesh_terms: D016025:Bone Transplantation / Q000379:methods; D005260:Female; D005270:Femur Head / Q000601:surgery / Q000637:transplantation*; D005500:Follow-Up Studies; D005534:Foot Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010020:Osteonecrosis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D011877:Radionuclide Imaging; D035583:Rare Diseases; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D013639:Tarsal Bones / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D020858:Tissue and Organ Harvesting; D014184:Transplantation, Homologous; D016896:Treatment Outcome