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Treatment of Traumatic Bone Loss of the Hand Using the Masquelet Technique
Vivien Moris, MD; David Guillier, MD1; Leslie Ann See, MD1; Alain Tchurukdichian, MD1; Francois Loisel, MD2; Isabelle Pluvy, MD2; Laurent Obert, MD2; Narcisse Zwetyenga, MD1
1University Hospital of Dijon, Dijon, France; 2University Hospital of Besancon, Besancon, France

This study proposes a prospective evaluation of eighteen patients treated for traumatic bone loss affecting the fingers, hand and wrist using the induced-membrane technique.
Sixteen men and two women, mean age 54 years (27-74) presented an injury including bone loss. Sixteen patients were treated in emergency and two had pseudarthroses following the fractures. There were 13 cases of open fractures of the phalanx and 5 cases of metacarpal fractures. These patients were treated with debridement and covered when necessary. As for the bone loss, the first step of the induced-membrane technique was performed placing the cement spacer (polymethyl methacrylate [PMMA]) without antibiotics, to replace the lost bone tissue.
During the second step the cement spacer was removed and replaced by an autologous cancellous bone graft. The graft was placed with the biological tube left empty after removal of the cement. For each patient, consolidation was assessed by radiography and/or CT-scan. Failure was defined as non-consolidation at one year. In 16 patients the fractures were consolidated after a mean 4 months (1.5 - 12 months). Two failures were noted (a pseudarthrosis treated using an IPP D3 prosthesis and one case of delayed consolidation). Mobility, evaluated using the TAM (Total Active Motion) was 145 (75 - 270) for the fingers. The Kapandji score reached 8 for the thumb. The grip strength measured using the Jamar reached 21 Kg/F and the pinch strength 5 Kg/F, both were half those in the healthy hand.
The induced-membrane technique is simple and can be used to treat traumatic bone loss in emergency, thus avoiding amputations and limb shortening, while preserving limb function. It provides immediate stability and thus allows early mobilization.


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