Osteomyelitis of the finger presents a challenging problem. Although there are multiple treatments described in the literature, infections that occur often result in eventual amputation.
We were recently presented with a case of an open fracture of the index finger complicated by non-union, infection, and osteomyelitis. The patient strongly preferred to avoid amputation, which seemed to be inevitable given their condition.
We took the decision to search for an alternative. We began conducting extensive research into the latest in treatment strategies. During this work, we came upon the two-stage Masquelet technique, which held promise as a potential solution.
What is the Masquelet Technique?
The Masquelet technique involves the use of a temporary cement spacer followed by staged bone grafting in order to manage posttraumatic bone defects.
This technique was first described for long-bone defects in the leg, and was found to be successful in both aseptic and septic conditions. While this recent treatment strategy had been found to be successful in treating long-bone defects in the legs, it had never been attempted in treating bone loss in the Phalanges.
After giving informed consent, the patient elected to attempt the Masquelet technique in this unique setting. The first time in the world that it would be attempted in treating bone loss and Osteomyelitis in the Phalanges.
Results From Using Masquelet Technique for Phalangeal Reconstruction
By following the Masquelet two-stage technique, we were able to salvage the use of the patient’s index finger with bony reconstruction and eradication of infection.
At their most recent follow up, fourteen months after the second stage of the Masquelet technique, the patient appeared free of infection. Their index finger metacarpophalangeal joint motion was 0-35 degrees, without interphalangeal joint motion.
They reported being satisfied with his finger function and was able to return to work as a state trooper. Their QuickDASH score was 0 at fourteen months after the first operation.
Learn if Masquelet Technique is Right for you
This experience shows that the Masquelet two-stage technique is a versatile tool that can also be applied in the treatment of bone loss with or without osteomyelitis of the phalanges. If you think that you have a condition or injury that may benefit from this innovative treatment strategy, please contact us today or call 212-249-8700 to schedule your consult.