gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Motion-preserving microvascular reconstruction of the distal radius after osteomyelitis

Meeting Abstract

  • presenting/speaker Higinio Ayala Gutierrez - Hospital Universitario Marques de Valdecilla, Unidad de Mano y Muñeca, Santander, Spain
  • Juan Ramon Sanz Gimenez-Rico - Hospital Universitario Marques de Valdecilla, Servicio de Cirugia Plastica y Reparadora, Santander, Spain
  • Manuel Ruben Sanchez Crespo - Hospital Universitario Marques de Valdecilla, Unidad de Mano y Muñeca, Santander, Spain
  • Guillermo Hernan De Piero Belmonte - Hospital Universitario Marques de Valdecilla, Servicio de Cirugia Plastica y Reparadora, Santander, Spain
  • Jose Couceiro Otero - Hospital Universitario Marques de Valdecilla, Unidad de Mano y Muñeca, Santander, Spain
  • Fernando Del Canto Alvarrez - Hospital Universitario Marques de Valdecilla, Unidad de Mano y Muñeca, Santander, Spain
  • Maria de los Angeles De La Red Gallego - Hospital Universitario Marques de Valdecilla, Unidad de Mano y Muñeca, Santander, Spain
  • Monica Fernandez Alvarez - Hospital Universitario Marques de Valdecilla, Servicio de Cirugia Ortopedica y Traumatologia, Santander, Spain
  • Vanessa Martinez Cortavitarte - Hospital Universitario Marques de Valdecilla, Santander, Spain

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-374

doi: 10.3205/19ifssh0157, urn:nbn:de:0183-19ifssh01571

Published: February 6, 2020

© 2020 Ayala Gutierrez et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: An open fracture of the upper extremity in the context of a high energy trauma is in a great risk of developing osteomyelitis of the damaged bones. Chronicity may occur, resulting in a pathological fracture, sequestrum formation and pseudarthrosis. When the distal radius is affected it leads to substantial bone loss that occasionally destroy de radiocarpal joint.

We present 2 cases of wide segmental bone loss at the distal radius affecting the radiocarpal joint due to chronic osteomyelitis, and different techniques to preserve motion at the midcarpal joint.

Methods:

  • Case #1: 57-year-old male, who works as policeman, presented in our clinic sustaining a chronic osteomyelitis of the distal radius after 3 months of treatment of an open intraarticular fracture of the distal radius while practicing paragliding as the initial injury. After resecting a segment of the distal radius including a portion of the articular surface, an antibiotic-impregnated cement spacer was placed to fill the gap. One month later, a free vascularized fibula transfer supplemented with a partial arthrodesis (Fibula-scaphoid-lunate) was performed to reconstruct the distal radius while maintaining some motion at the midcarpal level.
  • Case #2: 43-year-old male, who suffered 4 months ago an open intraarticular fracture of the distal radius after a motorbike accident, developed chronic osteomyelitis. In this case, the first row of the carpus was also affected by the osteomyelitis. After 6 weeks of treatment, a free fibula and a free vascularized ostheocondral graft from the base of the 3rd MTT was performed to reconstruct the segmental bone loss of the distal radius while keeping some motion at the midcarpal joint.

Results and Conclusions: The follow up of both patients is 2 years and 3 years respectively. The patients have returned to work and leisure activities with little impairment, although motion at wrist level has decreased.

CT scans confirm bone consolidation at both ends of the vascularized bone grafts without radiological defects or shortened bones.

A diverse variety of treatments have been proposed for reconstruction of extensive bone loss at the distal forearm for different conditions such trauma, bone tumours and osteomyelitis, but the vascularized free fibula graft still remains as the gold standard. When distal radius and proximal carpal row are affected motion can still be preserved by the means of either partial arthrodesis or reconstruction of the articular surface with a free vascularized osteochondral graft.