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; Ignacio Palafox-Carral; Ranulfo Romo-Rodríguez; Marisol Limón-Muñoz; Efraín Farías-Cisneros

doi:10.1055/s-0041-1736083

Journal of Hand and Microsurgery, Inhaltsverzeichnis

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

Authors

Francisco Guillermo Castillo-Vázquez

¹Department of Orthopedic Surgery, Centro Médico ABC, Ciudad de México, CDMX, Mexico
Ignacio Palafox-Carral

²Orthopedic Surgery Resident, Department of Orthopedic Surgery, Hospital Español de México, Mexico City, Mexico
Ranulfo Romo-Rodríguez

¹Department of Orthopedic Surgery, Centro Médico ABC, Ciudad de México, CDMX, Mexico
Marisol Limón-Muñoz

³Anesthesiology Division, Department of Regional Anesthesiology, Instituto Nacional de Rehabilitación “Luis Guillermo Ibarra Ibarra,” CDMX, Mexico
Efraín Farías-Cisneros

¹Department of Orthopedic Surgery, Centro Médico ABC, Ciudad de México, CDMX, Mexico

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

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Referenzen

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