Reconstruction of a Traumatic Partial First-Ray Amputation with the Use of an Induced Pseudosynovial Membrane and Corticocancellous Autograft

Abstract

Reconstruction of large bone defects of the metatarsals, whether resulting from trauma, infection, or a neoplastic process, can be especially challenging when attempting to maintain an anatomical parabola and basic biomechanical stability of the forefoot. We present the case of a 42-year-old man with no significant medical history who presented to the emergency department following a severe lawnmower injury to the left forefoot resulting in a large degloving type injury along the medial aspect of the left first ray extending to the level of the medial malleolus. The patient underwent emergent debridement with application of antibiotic bone cement, external fixation, and a negative-pressure dressing. He was subsequently treated with split-thickness skin graft and iliac crest tricortical autograft using a locking plate construct for reconstruction of the distal first ray. Although the patient failed to advance to radiographic osseous union, clinically there was no motion at the attempted fusion site and no pain with ambulation, suggestive of a pseudoarthrosis. The patient has since progressed to full nonpainful weightbearing in regular shoes and has returned to normal activities of daily living. The patient returned to his preinjury level of work and has had complete resolution of all wounds including his split-thickness skin graft donor site. This case shows the potential efficacy of the Masquelet technique for spanning significant traumatic bone defects of the metatarsals involving complete loss of the metatarsophalangeal joint.

Surgical Reconstruction of Nonunion after Iatrogenic Scarf Osteotomy

“…With respect to the fixation technique for fractures, although intramedullary screw fixation results in a high union rate, delayed healing and complications can occur [ 23 ]. Therefore, in recent years, many surgeons have preferred to use titanium plates and autografts to stabilize old fractures in the metatarsals [ 24 ] and to repair anatomical defects in the area as a consequence of trauma or tumor excision [ 25 , 26 ]. Titanium locking plate implants provide long-term stability and resistance to stress and strain in the forefoot.…”