Reverse radiodorsal artery-pedicled thumb metacarpal vascularized bone graft for osteochondral fracture of the thumb interphalangeal joint with a bone defect: A case report.
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
14
11
2019
revised:
21
06
2020
accepted:
24
09
2020
pubmed:
6
10
2020
medline:
29
7
2021
entrez:
5
10
2020
Statut:
ppublish
Résumé
Osteochondral fractures of the fingers are challenging to treat, and it is mandatory to acquire early bone union and joint surface reconstruction to obtain satisfactory outcomes. These injuries sometimes occur as open fractures with poor soft tissue condition and bone defect adjacent to osteochondral fragment. For such cases, surgical treatment can be more difficult, and vascularized bone graft (VBG) could be a useful method for joint reconstruction. Here, we report reverse-pedicled VBG based on the radiodorsal artery of the thumb for reconstructing a traumatic bone defect of the thumb. A 36-year-old man, who had ulcerative colitis and was taking immunosuppressive agents, sustained open fracture-dislocation of the thumb interphalangeal joint with a free osteochondral fragment of the proximal phalanx and 6 × 5 × 4 mm of subcondylar bone defect. We harvested 5 × 5 × 5 mm VBG at the base of the first metacarpal bone and dissected running the radiodorsal artery. The vascularized bone was grafted into the bone defect site through the subcutaneous tunnel created on the radial aspect of the proximal phalanx and fixed with a Kirschner wire. Bony union was obtained 2 months after surgery. At 7 months after the operation, the patient complained no pain, and the range of motion of the thumb interphalangeal joint was extension 0° and flexion 42°. Radiographs showed no avascular necrosis of the united fragment and osteoarthritis of the interphalangeal joint. This method could be a useful option for reconstruction of the thumb with bone defects.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
170-174Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Azi, M. L., Aprato, A., Santi, I., Kfuri, M., Masse, A., & Joeris, A. (2016). Autologous bone graft in the treatment of post-traumatic bone defects: A systematic review and meta-analysis. BMC Musculoskeletal Disorders, 17, 465.
Barrera-Ochoa, S., Mendez-Sanchez, G., Mir-Bullo, X., Knörr, J., Bertelli, J. A., & Soldado, F. (2019). Vascularized thumb metacarpal periosteal flap for scaphoid nonunion in adolescents: A prospective cohort study of 12 patients. The Journal of Hand Surgery, 44, 521.e521-521.e511.
Barrera-Ochoa, S., Mendez-Sanchez, G., Rodriguez-Baeza, A., Knörr, J., Bertelli, J. A., & Soldado, F. (2019). Vascularized thumb metacarpal periosteal pedicled flap for scaphoid nonunion: An anatomical study and pediatric case report. Microsurgery, 39, 62-69.
Bertelli, J. A., Pagliei, A., & Lassau, J. P. (1992). Role of the first dorsal metacarpal artery in the construction of pedicled bone grafts (27.3.92). Surgical and Radiologic Anatomy, 14, 275-277.
Bertelli, J. A., Tacca, C. P., & Rost, J. R. (2004). Thumb metacarpal vascularized bone graft in long-standing scaphoid nonunion- -a useful graft via dorsal or palmar approach: A cohort study of 24 patients. The Journal of Hand Surgery, 29, 1089-1097.
Clay, M., Mazouyes, A., Gilson, M., Gaudin, P., & Baillet, A. (2016). Risk of postoperative infections and the discontinuation of TNF inhibitors in patients with rheumatoid arthritis: A meta-analysis. Joint, Bone, Spine, 83, 701-705.
Cutting, C. B., & McCarthy, J. G. (1983). Comparison of residual osseous mass between vascularized and nonvascularized onlay bone transfers. Plastic and Reconstructive Surgery, 72, 672-675.
Davis, P. K., Mazur, J. M., & Coleman, G. N. (1982). A torsional strength comparison of vascularized and nonvascularized bone grafts. Journal of Biomechanics, 15, 875-880.
Harness, N., & Jupiter, J. B. (2004). The treatment of an osteochondral shearing fracture-dislocation of the head of the proximal phalanx: A case report. The Journal of Hand Surgery, 29, 925-930.
Hsu, C. C., Loh, C. Y., Lin, Y. T., & Lin, C. H. (2017). The medial femoral condyle flap for reconstruction of Intercondylar pathological fractures of the thumb. Plastic and Reconstructive Surgery. Global Open, 5, e1242.
Kumar, V. P., & Satku, K. (1995). Surgical management of osteochondral fractures of the phalanges and metacarpals: A surgical technique. The Journal of Hand Surgery, 20, 1028-1031.
Niikura, T., Lee, S. Y., Sakai, Y., Nishida, K., Kuroda, R., & Kurosaka, M. (2014). Causative factors of fracture nonunion: The proportions of mechanical, biological, patient-dependent, and patient-independent factors. Journal of Orthopaedic Science, 19, 120-124.
Ohno, Y., & Shimizu, K. (2005). Treatment of osteochondral fracture of the trochlea of the PIP joint. Archives of Orthopaedic and Trauma Surgery, 125, 706-712.
Pistre, V., Pelissier, P., Martin, D., & Baudet, J. (2001). Vascular blood supply of the dorsal side of the thumb, first web and index finger: Anatomical study. Journal of Hand Surgery (British), 26, 98-104.
Sammer, D. M., Bishop, A. T., & Shin, A. Y. (2009). Vascularized medial femoral condyle graft for thumb metacarpal reconstruction: Case report. The Journal of Hand Surgery, 34, 715-718.