# Reconstruction of a thumb metacarpophalangeal bone defect using the Masquelet technique: A case report

## TL;DR

This case report shows how the Masquelet technique can successfully reconstruct severe thumb bone defects, avoiding amputation.

## Contribution

The paper presents a novel application of the Masquelet technique in hand surgery for thumb reconstruction.

## Key findings

- The Masquelet technique preserved thumb function in a severe osteoarticular injury.
- Two-stage procedures may prevent amputation in post-infectious bone loss.
- Conservative salvage is a viable alternative to amputation or toe transfer.

## Abstract

Bone defects of the thumb secondary to trauma or infection pose a significant challenge for surgeons. The limited therapeutic options in such cases may, in the most severe scenarios, necessitate amputation, which has devastating functional consequences. The induced membrane technique, described by Masquelet, has proven effective in reconstructing bone loss in the lower limbs, particularly in septic contexts. However, its application in hand surgery remains underreported.

In this case, we describe a bone and joint defect of the thumb's metacarpophalangeal joint, complicated by osteoarthritis following a dog bite injury. After failure of initial osteosynthesis, resulting in bone and joint destruction, we performed a two-stage metacarpophalangeal arthrodesis using an iliac bone graft and Masquelet's technique.

The permanent use of a cement spacer is often employed in clinical practice, but it frequently leads to complications, including spacer fractures, pain, and dislocations. Our proposed method is simple, reproductible, and applicable in both emergency and non-emergency settings.

Our findings suggest that the Masquelet technique represents a promising reconstructive option for managing bone loss in osteitis with a high risk of amputation. This approach enables the preservation of sufficient thumb length to maintain pollici-digital function, allowing for satisfactory gripping ability. Further long-term studies are necessary to confirm these preliminary results.

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•The Masquelet technique can effectively preserve thumb function in severe osteoarticular injuries.•Two-stage induced membrane procedures may avoid amputation in post-infectious bone loss.•Conservative salvage should be considered prior to alternatives like amputation or toe transfer

The Masquelet technique can effectively preserve thumb function in severe osteoarticular injuries.

Two-stage induced membrane procedures may avoid amputation in post-infectious bone loss.

Conservative salvage should be considered prior to alternatives like amputation or toe transfer