The use of the induced membrane technique in an open fracture of the first phalangeal column of the thumb

Abstract

The case involves a 53-year-old patient admitted for trauma to the right hand following an accident with a grinder. The 4 cm wound on the first ray caused a tendon deficit without vascular or nerve damage. An open fracture of the first metacarpal with a 2 cm bone loss was diagnosed. Initial treatment included wound irrigation, debridement, suturing, and osteosynthesis using biological cement and a Bone fixation using Iselin pinning with two K-wires. A second procedure, six weeks later, involved a bone graft using the Masquelet technique, showing bone consolidation after five months. This technique is proving increasingly effective for complex open fractures, promoting vascularization and cortication through the release of growth factors like BMP-2 and VEGF. Studies confirm the presence of osteoclasts and osteoblasts in the induced membrane, aiding osteointegration. Initially developed for the lower limb, the technique has successfully been extended to the hand, providing a viable option for bone substance loss.