Lagarde Gauthier, Alawadhi Omar, Camuzard Olivier, Balaguer Thierry, Monin Brieuc, Lupon Elise
Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, Nice, France.
Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, Nice, France.
Int J Surg Case Rep. 2025 Jun;131:111425. doi: 10.1016/j.ijscr.2025.111425. Epub 2025 May 13.
Bone defects of the thumb secondary to trauma or infection pose a significant challenge for surgeons. The limited therapeutic options in such cases may, in the most severe scenarios, necessitate amputation, which has devastating functional consequences. The induced membrane technique, described by Masquelet, has proven effective in reconstructing bone loss in the lower limbs, particularly in septic contexts. However, its application in hand surgery remains underreported.
In this case, we describe a bone and joint defect of the thumb's metacarpophalangeal joint, complicated by osteoarthritis following a dog bite injury. After failure of initial osteosynthesis, resulting in bone and joint destruction, we performed a two-stage metacarpophalangeal arthrodesis using an iliac bone graft and Masquelet's technique.
The permanent use of a cement spacer is often employed in clinical practice, but it frequently leads to complications, including spacer fractures, pain, and dislocations. Our proposed method is simple, reproductible, and applicable in both emergency and non-emergency settings.
Our findings suggest that the Masquelet technique represents a promising reconstructive option for managing bone loss in osteitis with a high risk of amputation. This approach enables the preservation of sufficient thumb length to maintain pollici-digital function, allowing for satisfactory gripping ability. Further long-term studies are necessary to confirm these preliminary results.
创伤或感染继发的拇指骨缺损给外科医生带来了重大挑战。在这种情况下，有限的治疗选择在最严重的情况下可能需要截肢，这会带来严重的功能后果。Masquelet描述的诱导膜技术已被证明在重建下肢骨缺损方面有效，特别是在感染情况下。然而，其在手部手术中的应用报道仍然较少。
在本病例中，我们描述了一例拇指掌指关节的骨与关节缺损，该缺损因犬咬伤后并发骨关节炎。初次骨固定失败导致骨与关节破坏后，我们采用髂骨移植和Masquelet技术进行了两阶段掌指关节融合术。
临床实践中常长期使用骨水泥间隔物，但它经常导致并发症，包括间隔物骨折、疼痛和脱位。我们提出的方法简单、可重复，适用于急诊和非急诊情况。
我们的研究结果表明，Masquelet技术是一种有前景的重建选择，可用于治疗有截肢高风险的骨髓炎中的骨缺损。这种方法能够保留足够的拇指长度以维持拇指-手指功能，实现令人满意的抓握能力。需要进一步的长期研究来证实这些初步结果。
