Download PDF
J Hand Microsurg 2022; 14(01): 100-106
DOI: 10.1055/s-0041-1736083
Ideas and Innovations

Surgical Solution for Total Carpectomy due to Destructive Wrist Pan-Osteomyelitis Using a Free Femoral Condyle Osteocutaneous Flap for Wrist Arthrodesis

Francisco Guillermo Castillo-Vázquez
1   Department of Orthopedic Surgery, Centro Médico ABC, Ciudad de México, CDMX, Mexico
,
Ignacio Palafox-Carral
2   Orthopedic Surgery Resident, Department of Orthopedic Surgery, Hospital Español de México, Mexico City, Mexico
,
Ranulfo Romo-Rodríguez
1   Department of Orthopedic Surgery, Centro Médico ABC, Ciudad de México, CDMX, Mexico
,
Marisol Limón-Muñoz
3   Anesthesiology Division, Department of Regional Anesthesiology, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra,” CDMX, Mexico
,
Efraín Farías-Cisneros 
1   Department of Orthopedic Surgery, Centro Médico ABC, Ciudad de México, CDMX, Mexico
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Osteomyelitis of the hand is rare, even more so in the carpal bones. Patients with rheumatoid arthritis (RA) have a higher infection rate overall, and up to a 14-fold increase in the incidence of septic arthritis of the hand. The destruction of immunologic barriers, such as cartilage and joint capsules, as well as the use of immunosuppressive medications will have an impact on the higher incidence of articular infections and osteomyelitis in these patients. Infection in these cases is often overlooked because of the similarity of presentation to an acute event of RA. When osteomyelitis is present, rapid and aggressive treatment should be given. Surgical debridement, lavage, and excision of necrotic bone is the best choice, followed by cemented antibiotic impregnated spacer to resolve the acute scenario. Vascularized bone grafts (VBG) can then be used for a definitive solution, as these have great biologic properties that increase the possibility of a good outcome. We hereby present a report of a wrist arthrodesis, using a free medial femoral condyle VBG for the treatment of destructive osteomyelitis of the carpal bones in a female patient with RA.

Keywords

Osteomyelitis - Vascularized Bone Graft - Carpal Bones - Rheumatoid Arthritis - Cemented Spacer


Publication History

Article published online:
29 September 2021

© 2021. Society of Indian Hand & Microsurgeons. This article is published by Thieme.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Ngo ST, Steyn FJ, McCombe PA. Gender differences in autoimmune disease. Front Neuroendocrinol 2014; 35 (03) 347-369
    CrossrefPubMedGoogle Scholar
  • 2 Smolen JS, Aletaha D, Barton A. et al. Rheumatoid arthritis. Nat Rev Dis Primers 2018; 4 (01) 18001
    CrossrefPubMedGoogle Scholar
  • 3 Alamanos Y, Drosos AA. Epidemiology of adult rheumatoid arthritis. Autoimmun Rev 2005; 4 (03) 130-136
    CrossrefPubMedGoogle Scholar
  • 4 Cantley M, Smith M, Haynes D. Pathogenic bone loss in rheumatoid arthritis: mechanisms and therapeutic approaches. Int J Clin Rheumatol 2009; 4 (05) 561-582
    CrossrefPubMedGoogle Scholar
  • 5 Raven EE, van den Bekerom MP, Beumer A, van Dijk CN. Radiocarpal and midcarpal instability in rheumatoid patients: a systematic review. Open Orthop J 2015; 9 (01) 246-254
    CrossrefPubMedGoogle Scholar
  • 6 Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg 1991; 87 (02) 290-298
    CrossrefPubMedGoogle Scholar
  • 7 Mehta B, Pedro S, Ozen G. et al. Serious infection risk in rheumatoid arthritis compared with non-inflammatory rheumatic and musculoskeletal diseases: a US national cohort study. RMD Open 2019; 5 (01) e000935
    CrossrefPubMedGoogle Scholar
  • 8 Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 2002; 46 (09) 2287-2293
    CrossrefPubMedGoogle Scholar
  • 9 Goldenberg DL. Infectious arthritis complicating rheumatoid arthritis and other chronic rheumatic disorders. Arthritis Rheum 1989; 32 (04) 496-502
    CrossrefPubMedGoogle Scholar
  • 10 Holland C, Jaeger L, Smentkowski U, Weber B, Otto C. Septic and aseptic complications of corticosteroid injections: an assessment of 278 cases reviewed by expert commissions and mediation boards from 2005 to 2009. Dtsch Arztebl Int 2012; 109 (24) 425-430
    PubMedGoogle Scholar
  • 11 Wronka KS, Sinha A. Calcaneal osteomyelitis following steroid injection for plantar fasciitis: a case report. Foot Ankle Spec 2012; 5 (04) 253-255
    CrossrefPubMedGoogle Scholar
  • 12 Mattos D, Ko JH, Iorio ML. Wrist arthrodesis with the medial femoral condyle flap: Outcomes of vascularized bone grafting for osteomyelitis. Microsurgery 2019; 39 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 13 Pinder R, Barlow G. Osteomyelitis of the hand. J Hand Surg Eur Vol 2016; 41 (04) 431-440
    CrossrefPubMedGoogle Scholar
  • 14 Gill P, Lambah A. Osteomyelitis of the hand. Trauma 2013; 16 (01) 48-50
    CrossrefPubMedGoogle Scholar
  • 15 Wong VW, Higgins JP. Medial femoral condyle flap. Plast Reconstr Surg Glob Open 2016; 4 (08) e834
    CrossrefPubMedGoogle Scholar
  • 16 Yajima H, Kobata Y, Tomita Y, Kawate K, Sugimoto K, Takakura Y. Ankle and pantalar arthrodeses using vascularized fibular grafts. Foot Ankle Int 2004; 25 (01) 3-7
    CrossrefPubMedGoogle Scholar
  • 17 Capanna R, Campanacci DA, Belot N. et al. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques. Orthop Clin North Am 2007; 38 (01) 51-60, vi
    CrossrefPubMedGoogle Scholar
  • 18 Doi K, Akino T, Shigetomi M, Muramatsu K, Kawai S. Vascularized bone allografts: review of current concepts. Microsurgery 1994; 15 (12) 831-841
    CrossrefPubMedGoogle Scholar
  • 19 González del Pino J, Bartolomé del Valle E, Graña GL, Villanova JF. Free vascularized fibular grafts have a high union rate in atrophic nonunions. Clin Orthop Relat Res 2004; ; ( (419) 38-45
    CrossrefPubMedGoogle Scholar
  • 20 Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 2010; 41 (01) 27-37
    CrossrefPubMedGoogle Scholar
  • 21 Georgiadis GM, DeSilva SP. Reconstruction of skeletal defects in the forearm after trauma: treatment with cement spacer and delayed cancellous bone grafting. J Trauma 1995; 38 (06) 910-914
    CrossrefPubMedGoogle Scholar
  • 22 Rodríguez-Vegas JM, Delgado-Serrano PJ. Corticoperiosteal flap in the treatment of nonunions and small bone gaps: technical details and expanding possibilities. J Plast Reconstr Aesthet Surg 2011; 64 (04) 515-527
    CrossrefPubMedGoogle Scholar
  • 23 Kazmers NH, Thibaudeau S, Steinberger Z. Scott Levin L. Upper and lower extremity reconstructive applications utilizing free flaps from the medial genicular arterial system: a systematic review. Microsurgery 2018; 38 (03) 328-343
    CrossrefPubMedGoogle Scholar
  • 24 Katz RD, Parks BG, Higgins JP. The axial stability of the femur after harvest of the medial femoral condyle corticocancellous flap: a biomechanical study of composite femur models. Microsurgery 2012; 32 (03) 213-218
    CrossrefPubMedGoogle Scholar
  • 25 Endara MR, Brown BJ, Shuck J, Bachabi M, Parks BG, Higgins JP. Torsional stability of the femur after harvest of the medial femoral condyle corticocancellous flap. J Reconstr Microsurg 2015; 31 (05) 364-368
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Iorio ML, Masden DL, Higgins JP. The limits of medial femoral condyle corticoperiosteal flaps. J Hand Surg Am 2011; 36 (10) 1592-1596
    CrossrefPubMedGoogle Scholar
  • 27 Boretto JG, Altube G, Gallucci GL, Narvaez HR, De Carli P. Femoral osteonecrosis after medial femoral condyle bone graft harvest. Plast Reconstr Surg Glob Open 2018; 6 (06) e1792
    CrossrefPubMedGoogle Scholar
  • 28 Iorio ML, Moran SL. Ch. 39. Medial femoral condyle flap. In: Chung KC and Moran SL, eds. ASSH Surgical Anatomy: Flap Reconstruction. 1st ed. Chicago: American Society for Surgery of the Hand 2018: 284-295
  • 29 Kumta S, Warrier S, Jain L, Ummal R, Menezes M, Purohit S. Medial femoral condyle vascularised corticoperiosteal graft: a suitable choice for scaphoid non-union. Indian J Plast Surg 2017; 50 (02) 138-147
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Taniguchi Y, Yoshida M, Doi N, Tamaki K, Tamaki T. Vascularized fibular osteocutaneous grafts in the treatment of severely infected wrist arthritis. J Reconstr Microsurg 2002; 18 (02) 71-75
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 McKay P, Formby P, Dickens J, Gibson M. Osteomyelitis and septic arthritis of the hand and wrist. Curr Orthop Pract 2010; 21 (06) 542-550
    CrossrefPubMedGoogle Scholar