No abstract

Osteomyelitis of the epiphysis after a distal radius fracture is uncommon. If not adequately and promptly treated, the detrimental effects on wrist function can be devastating. However, management of septic bone defects of the epiphysis is significantly challenging. We report the case of a patient with juxta-articular distal radius osteomyelitis successfully treated with a free vascularised corticoperiosteal flap from the medial femoral condyle (MFC corticoperiosteal flap). A 46-year-old right-handed man fell on the grass from a height of 2 m during a demolition. He was diagnosed with a right distal radius and ulnar styloid process fracture. He underwent open reduction and internal fixation. However, he developed a deep infection, resulting in postoperative osteomyelitis. Therefore, thorough debridement was performed and an external fixator was applied. Antibiotics were administered according to the culture results. He underwent reconstruction for bone defect using an MFC corticoperiosteal flap 28 days after re-operation. The patient could resume work without limitations 4 months after the reconstruction. The infection subsided completely, and radiographs confirmed bone union at 5 months after the reconstruction. His wrist range of motion was 40° in dorsal flexion (uninjured side 70°), 50° in palmar flexion (75°), 80° in supination (90°), and 90° in pronation (90°). There was no donor site complication. The patient has reported no pain for 1 year since the injury. The use of the MFC corticoperiosteal flap for reconstruction of the juxta-articular distal radius osteomyelitis decreased the time required for bone union, enabled local antibiotic delivery to control infection, and helped preserve wrist function.

Figure 2. (a) The tumour at the distal end of the supinator muscle, covered with thin nerve fibres (arrow). (b) After excision. (c) Histology reveals hyperplasia of adipocyte tissue. The scale bar indicates 100 micrometres.

This study documented the treatment of the inguinal dead space with chronic infection using musculocutaneous flaps. The average age of the patients (5 males and 2 females) was 50.0 years. Six cases of reconstruction after malignant tumor resection and one case after total hip arthoroplasty were treated. Six rectus abdominis flaps and 2 vastus lateralis flaps were used. Previous radiation therapy had been performed on five patients. The duration of chronic infection averaged 2.3 months, excluding a 4- year long case. All flaps survived and the average follow-up period was 2.8 years. Five cases had no relapse of the infection but two cases relapsed 18 months and 2 years respectively after the surgery. These two did not have tumor prostheses removed prior to the surgery.

Although nerve autografts have been considered the standard treatment for peripheral nerve defects, limited studies have reported long-term outcomes of nerve harvesting over 15 years after surgery. This study aimed to evaluate the long-term outcomes of donor site morbidity after sural nerve graft harvesting. Methods: Thirteen patients for whom more than 15 years had passed after harvesting of the sural nerve for peripheral nerve defects were included. Mean follow-up was 29.5 years. Sensory disturbances and difficulty in performing foot movements immediately after surgery and currently were evaluated on a 10-point scale. Influences on daily living and work and current satisfaction with the autologous sural nerve graft were evaluated. Results: Sensory disturbances and difficulty in movement tended to improve; however, the differences between time points were not significant. Influences on activities of daily living and work were mild, and the satisfaction level for autologous sural nerve graft was high. Conclusions: Although donor site morbidity after sural nerve graft harvesting persisted for a long time after surgery, foot symptoms and functional impairment were mild. Type of study/level of evidence: Therapeutic V.