Bone loss in the hand

Radial Half of the Second Metacarpal Bone and the First Dorsal Interosseous Muscle Composite Flap for Treating the First Metacarpal Bone Defect: A Case Report

Traumatic bone defect is a challenging problem for both patient and doctor. The goal of treatment is the restoration of hand function with acceptable appearance of an injured hand. Especially in the injury of the thumb, length and stability are very important to achieve good holding and pinching functions. We reported a 23-year-old patient with traumatic first metacarpal bone loss after a motor vehicle accident treated with vascularized radial half of the second metacarpal bone and the first dorsal interosseous muscle composite flap.

Digital Joint Reconstruction with Osteotendinous Joint Allograft: Experimental Study in Rats

Background:

Fresh or frozen nonvascularized osteotendinous joint allografts (OTJA) have not been used previously, clinically or experimentally, for metacarpophalangeal joint reconstruction. Therefore, we evaluated the viability of OTJA for metatarsophalangeal joint (MTJ) reconstruction in rats.

Methods:

In the experimental group of 12 Lewis rats, we reconstructed the MTJ of the third digit of the hindlimb with a fresh, nonvascularized OTJA obtained from the same digit from 12 donor rats. In the control group of 6 Lewis rats, an autologous composite osteotendinous graft of the MTJ of the same digit was obtained and repositioned in situ as an auto-transplant. Weight, pain, edema, dehiscence, and wound infection were evaluated every 24 hours for 30 days postoperatively. At the end of 30 days, we evaluated digit position, flexion and extension, passive mobility, radiological bone healing, and histological grades of rejection.

Results:

We found no statistically different changes in weight, edema, pain, digit position, or radiological bone healing in either group. No wound dehiscence or infection was seen in any of the rats. Ten degrees of flexion and extension mobility were lost in the control group; the experimental group lost up to 30 degrees (P = 0.009). Histologically, 9 of the experimental group rats (9/12, 75%) showed rejection reactions compared with none of the controls (0%) (P = 0.009).

Conclusions:

Fresh nonvascularized OTJA caused an immune reaction without exposure of the graft, but with bone resorption. However, the rats maintained digital form and alignment with decreased passive flexion and extension of 10–30 degrees.

Challenges Posed by Delayed Presentation of Mutilating Hand Injuries

Management of mutilating hand injury is a challenge for any hand surgeon. Delay in presentation makes management even more challenging, usually because of inadequate initial assessment, inadequate debridement leading to infection, and secondary loss of tissues from exposure and desiccation. The aim is to obtain a functional hand by radical debridement, adequate assessment of the injury, appropriately timed reconstruction, and physiotherapy and rehabilitation. The hand surgeon must pay attention to the appearance of the hand by elimination of deformities, unsightly scars and bulky flaps to help to restore confidence in the patient to face the demands of daily living.