Functional and radiographic evaluation of the treatment of traumatic bone loss of the hand using the Masquelet technique.
This study was a retrospective evaluation of 18 patients with traumatic bone loss affecting the fingers, hand and wrist who were treated using the induced-membrane technique. Sixteen men and two women, mean age 54years (27-74) presented a hand injury including bone loss. Sixteen patients were treated on an emergency basis and two following nonunion of their fractures. There were 13 cases of open fracture of the phalanx and 5 cases of metacarpal fractures. These patients were treated with debridement and the injuries were covered when necessary. To address the bone loss, the first step of the induced-membrane technique involved placing a cement spacer (polymethylmethacrylate [PMMA]) without antibiotics in the defect. During the second step, the cement spacer was removed and replaced by autologous cancellous bone graft. The graft was placed within the biological tube left empty after removal of the cement. For each patient, bone union was assessed with radiographs and/or CT scan. Failure was defined as nonunion at 1year. In 16 patients, the fractures had healed after 4months (1.5-12months) on average. Two failures were noted (one nonunion treated using a PIP prosthesis and one case of delayed union). Mobility of the fingers, evaluated using the Total Active Motion (TAM) was 145° (75°-270°). The Kapandji score reached 8 for the thumb. Grip strength reached 21kg/F and pinch strength was 5kg/F; these values were 50% of those in the healthy hand. The induced-membrane technique is simple and can be used to treat traumatic bone loss in an emergency, thus avoiding amputation and limb shortening, while preserving limb function. It provides immediate stability and allows early mobilization.
Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France. Electronic address: morisvivien2@hotmail.com.
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Moris
Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France. Electronic address: francois_loisel@yahoo.fr.
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Loisel
Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
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Cheval
Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France. Electronic address: leslieannsee@gmail.com.
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See
Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France. Electronic address: alaintchu@bbox.fr.
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Tchurukdichian
Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France. Electronic address: isabelle@pluvy.com.
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Pluvy
Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
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Gindraux
Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France. Electronic address: Julien.pauchot@gmail.com.
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Pauchot
Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France. Electronic address: nzwetyenga@gmail.com.
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Zwetyenga
Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France. Electronic address: laurentobert@yahoo.fr.
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Obert
D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use; D016025:Bone Transplantation / Q000379:methods*; D003646:Debridement; D005260:Female; D005383:Finger Injuries / Q000601:surgery; D050278:Finger Phalanges / Q000293:injuries*; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery*; D005597:Fractures, Open / Q000601:surgery; D005599:Fractures, Ununited / Q000601:surgery; D006230:Hand Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D050279:Metacarpal Bones / Q000293:injuries*; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000601:surgery*
D001843:Bone Cements
Bone loss; Emergency; Fracture ouverte; Functional assessment; Hand; Induced membranes; Main; Masquelet technique; Membranes induites; Nonunion; Open fracture; Perte osseuse; Pseudarthrose; Technique de Masquelet; Trauma; Traumatisme; Urgence; Évaluation fonctionnelle