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Saito, Taichi Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences ORCID Kaken ID
Noda, Tomoyuki Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Kaken ID
Kondo, Hiroya Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences ORCID Kaken ID
Demiya, Koji Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences
Nezu, Satoshi Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences
Yokoo, Suguru Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences
Matsuhashi, Minami Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences
Uehara, Takenori Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences
Shimamura, Yasunori Department of Sports Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Kaken ID
Kodama, Masayuki Mizushima Central Hospital
Ozaki, Toshifumi Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences Kaken ID publons researchmap
Abstract
Septic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated the effectiveness of the Masquelet technique in the treatment of bone defects caused by trauma or infection. However, only few studies have reported the use of this technique for septic arthritis in small joints of the hand, and its effectiveness in treating septic arthritis in DIP joints remains unclear. We report the clinical and radiological outcomes of three patients who were treated with the Masquelet technique for septic arthritis in DIP joints. One patient had uncontrolled diabetes and another had rheumatoid arthritis treated with methotrexate and prednisolone. The first surgical stage involved thorough debridement of the infection site, including the middle and distal phalanx. We placed an external fixator from the middle to the distal phalanx and then packed the cavity of the DIP joint with antibiotic cement bead of polymethylmethacrylate (40 g) including 2 g of vancomycin and 200 mg of minocycline. At 4-6 weeks after the first surgical stage, the infection had cleared, and the second surgical stage was performed. The external fixator and cement bead were carefully removed while carefully preserving the surrounding osteo-induced membrane. The membrane was smooth and nonadherent to the cement block. In the second surgical stage, an autogenous bone graft was harvested from the iliac bone and inserted into the joint space, within the membrane. The bone graft, distal phalanx, and middle phalanx were fixed with Kirschner wires and/or a soft wire. Despite the high risk of infection, bone union was achieved in all patients without recurrence of infection. Although the Masquelet technique requires two surgeries, it can lead to favorable clinical and radiological outcomes for infected small joints of the hand.
Abstract Alternative
Septic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated...
Keywords
Hand
Induced membrane
Masquelet technique
Septic arthritis
The small joint
Published Date
2020-02-29
Publication Title
Trauma Case Reports
Volume
volume25
Start Page
100268
ISSN
23526440
Content Type
Journal Article
language
英語
OAI-PMH Set
岡山大学
Copyright Holders
© 2019 The Authors. Published by Elsevier Ltd.
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publisher
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DOI
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isVersionOf https://doi.org/10.1016/j.tcr.2019.100268
License
http://creativecommons.org/licenses/by-nc-nd/4.0/
Citation
Saito T, Noda T, Kondo H, et al. The Masquelet technique for septic arthritis of the small joint in the hands: Case reports. Trauma Case Rep. 2019;25:100268. Published 2019 Dec 17. doi:10.1016/j.tcr.2019.100268
Open Access (Publisher)
OA
Open Archive (publisher)
Non-OpenArchive