Finger Rescue Using the Induced Membrane Technique for Osteomyelitis of the Hand

Abstract

Background: The induced membrane technique is now commonly used for large diaphyseal bone defects. Recently, several papers reported using the induced membrane technique for hand surgery. We applied this technique with some modifications to treat osteomyelitis of the phalanges. Methods: This study included six men and one woman with a mean age of 56 years. The causes of osteomyelitis included animal bite (n = 3), trauma (n = 3), and an indwelling needle (n = 1). Two-staged surgeries were performed, including an initial stage with radical debridement of the infected tissue and placement of a cement spacer into the bone defect. Four weeks after the first stage, a bone graft was performed. A bone block with cortex was harvested from the iliac crest or radius, and costal cartilage was used for proximal interphalangeal (PIP) joint arthroplasty in two cases. Grafted bones were fixed with a mini screw or an external fixator. Results: In all cases, the infection subsided, and bone union was obtained within two to three months. No absorption of the grafted bone was observed. In the two cases with PIP joint defect, joint motion without pain was preserved at 56° and 26°. Conclusions: A short interval between the two surgical stages of the induced membrane technique could be advantageous for patients in terms of time and financial burden and early rehabilitation of movement. Cortico-cancellous bone grafts were able to maintain bone length and stability with screw fixation. In the cases with PIP joint defects, instead of arthrodesis, we performed PIP arthroplasty using costal cartilage, eventually obtained some motion without pain. The induced membrane technique was useful and technically feasible for treating osteomyelitis in the hand, and secondary joint reconstruction was possible to obtain some motion.

Masquelet Technique and Arthrodesis for Digit Salvage of the Finger in Traumatic Bone Loss and Osteomyelitis: A Case Report

“…Toyama et al utilized the induced membrane technique for the treatment of osteomyelitis of the phalanges in seven patients. In this report, a four-week interval was used between cement spacing and bone graft for early rehabilitation and decreased burden on the patient [3]. However, Tabib et al reported on the treatment of chronic osteomyelitis of the second metacarpal following treatment of a Bennett fracture via the induced membrane technique with an eight-week interval between stages and successful bony union [6].…”

“…Despite its prevalence in the lower extremities, case reports and series on the successful use of the Masquelet technique are also described in the upper extremity. These studies have described its use in treating bone loss secondary to trauma, osteomyelitis, or nonunion, as well as for arthrodesis or septic arthritis [3][4][5][6][7][8][9]. In this article, we present the case of a patient who sustained a gunshot wound resulting in traumatic bone loss, articular surface destruction, and subsequent osteomyelitis following initial treatment, and ultimately underwent the Masquelet procedure with successful arthrodesis of the distal interphalangeal (DIP) joint as an alternative to digit amputation.…”

Zweizeitige Arthrodese bei knöchernen Fingergelenkdefekten – Langfristige Ergebnisse

“…Die genannten Nachteile sollten mit den Patienten besprochen und die Behandlung an ihre individuellen Anforderungen angepasst werden. Gelenkerhaltende Alternativen zur Knochenrekonstruktionen der Phalangen mit Beckenkammspan kombiniert mit eingeschlagener palmarer Platte oder Rippenknorpel als Arthroplastiken können vorgeschlagen werden [13,19]. Langfristig führen die Verfahren jedoch zu Arthrosen der Neogelenke, insbesondere im Mittelgelenk, so dass zweizeitig eine Arthrodese oder Prothese erforderlich werden kann [13,14].…”

Treating post-traumatic osteomyelitis of a metacarpal fracture with the ‘mini-masquelet’ procedure

“…Previously, a case series was reported of seven patients who underwent the masquelet procedure for osteomyelitis of phalanges of various etiologies [ 3 ]. In all patients, a cement spacer was placed after radical debridement and removed after four weeks to facilitate rapid rehabilitation.…”