Greco Victor E, Hammarstedt Jon E, O'Connor Shaelyn, Regal Steven
Department of Orthopaedic Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, Pennsylvania, United States.
J Orthop Case Rep. 2022 Apr;12(4):49-53. doi: 10.13107/jocr.2022.v12.i04.2762.
Distal radius fractures are one of the most common fractures in the United States. Treatment usually involves internal fixation using a volar Henry approach with placement of a volar locking plate. Optimal treatment becomes less apparent when significant bone loss occurs. No case of an open distal radius fracture treated using a staged Masquelet technique involving proximal tibial autograft is available in the literature. Herein, we describe and discuss a case report of a novel technique to treat a large (5 cm) bone defect for an open distal radius fracture.
A 59-year-old man suffered an open, comminuted, and intra-articular distal radius fracture with 5 cm of bone loss. He was treated using a staged Masquelet technique with incorporation of ipsilateral proximal tibial autograft with a bone harvester to obtain cancellous autograft and bone marrow graft. The patient initially underwent emergent I and D, acute carpal tunnel release, and internal and external fixation. A 5 cm bone void was filled with antibiotic cement. Four weeks later, the antibiotic cement was removed, cancellous bone graft and marrow were harvested from the proximal tibia, and the graft was placed within the prior bone void. Fracture site healing was confirmed radiographically and with computer-tomography imaging 3 months later. The patient has demonstrated excellent results 1 year post-operative with 60° of wrist flexion, 40° of wrist extension with mild pain, and full finger range of motion with radiographic union.
Internal fixation with placement of a volar locking plate remains the mainstay of treatment for distal radial fractures. However, in more comminuted fractures with bone loss, treatment becomes more challenging. We have presented a unique case utilizing a staged Masquelet technique with incorporation of a proximal tibial autograft to educate readers on an alternative option and technique for autograft donor sites in these more complicated fractures.
桡骨远端骨折是美国最常见的骨折之一。治疗通常采用掌侧Henry入路进行内固定，并放置掌侧锁定钢板。当出现明显骨缺损时，最佳治疗方案就不那么明显了。文献中尚无使用分期Masquelet技术并结合胫骨近端自体骨移植治疗开放性桡骨远端骨折的病例。在此，我们描述并讨论一例采用新技术治疗开放性桡骨远端骨折导致的大（5厘米）骨缺损的病例报告。
一名59岁男性遭受开放性、粉碎性和关节内桡骨远端骨折，伴有5厘米的骨缺损。他接受了分期Masquelet技术治疗，使用骨采集器采集同侧胫骨近端的自体骨以获取松质骨自体骨和骨髓移植。患者最初接受了急诊清创、急性腕管松解以及内外固定。一个5厘米的骨缺损用抗生素骨水泥填充。四周后，取出抗生素骨水泥，从胫骨近端采集松质骨移植和骨髓，并将移植物放置在先前的骨缺损处。3个月后通过X线和计算机断层扫描成像确认骨折部位愈合。术后1年，患者取得了优异的效果，腕关节屈曲60°，腕关节伸展40°，伴有轻度疼痛，手指活动范围完全正常，影像学显示骨折愈合。
放置掌侧锁定钢板进行内固定仍然是桡骨远端骨折治疗的主要方法。然而，对于更粉碎且伴有骨缺损的骨折，治疗变得更具挑战性。我们展示了一个独特的病例，采用分期Masquelet技术并结合胫骨近端自体骨移植，旨在让读者了解在这些更复杂骨折中自体骨供区的另一种选择和技术。
