Replantation of digits or hands followed by destructive joint disease.

Abstract

The clinical records and radiographs of 45 patients who had undergone replantation of a total hand, or a part thereof, were reviewed in order to determine the prevalence and the type of articular changes occurring distal to the site of anastomoses. In three patients, destructive joint changes were observed, consisting of bony fragmentation, spiculation, and cystic or erosive lesions. These changes, which developed between five and ten months after replantation, are most likely neuropathic or osteonecrotic in pathogenesis.

Destructive Arthropathy of the Interphalangeal Joint Following Revascularization After Degloving Hand Injury: A Case Report

“…They reported that the presence of soft tissue viability may not be a true indicator of bone viability. 9 Indeed, in our case, the soft tissue envelope of the respective fingers had an acceptable appearance without resultant atrophic changes. The cause of this destructive articular lesion was speculated to be small vessel compromise and microinfarction.…”

“…Therefore, we suggest that destructive arthropathy following degloving injury should be recognized as a potential complication affecting functional outcome. Gueraa et al 9 described the development of destructive arthropathy following replantation of digits without osteonecrosis with sufficient reconstitution of blood flow to prevent soft tissue necrosis. They reported that the presence of soft tissue viability may not be a true indicator of bone viability.…”

“…The cause of this destructive articular lesion was speculated to be small vessel compromise and microinfarction. 9 The most likely areas to undergo ischemia and subsequent infarction are the subchondral regions and pannus-like tissue would result in subchondral bone and joint cartilage destruction. 9 Small vessel compromise and microinfarction could be more likely to occur in degloving injury than in digit amputation.…”

“…9 The most likely areas to undergo ischemia and subsequent infarction are the subchondral regions and pannus-like tissue would result in subchondral bone and joint cartilage destruction. 9 Small vessel compromise and microinfarction could be more likely to occur in degloving injury than in digit amputation. Longitudinal traction and crush, which is the mechanism of degloving injury, causes occult injury to the nutrient arteries of the phalanges and avulsion from the nutrient foramina.…”