Técnica de Masquelet para defecto óseo en quinto metatarsiano. Reporte de caso clínico

Background

The Masquelet technique is used in the treatment of bone defects in long bones with high success rete reports. It has been described for the treatment of bone loss in the 1st metatarsal and midfoot. The aim of the report is to describe the experience with the technique in a patient with a bone defect of the fourth and fifth metatarsals associated with a transfixing skin defect.

Case report

In a 42-year-old patient who presented a gunshot wound to the lateral column of the right foot with subsequent transfixing coverage defect and bone defect due to comminuted fracture of the fourth and fifth metatarsals. Surgical treatment was performed in 3 stages, the first stabilization and surgical lavage, 2nd stage coverage with a reverse flow sural flap, fixation with a plate and a cement spacer. For a third stage, the bone cement was removed and an autologous cortico-cancellous bone graft was placed. Clinical and radiological follow-up was carried out for 18 months.

Results

The patient did not present complications including infection, presented anesthesia area in the sural nerve territory, complete viability of the flaps. Normal gait without metatarsalgia was evidenced and in the radiological evaluation it presents graft integration of 90% at described follow up term. Adequate space over the metatarsal cuboid interposition arthroplasty was observed, with a VAS of 1/10 and an AOFAS mid foot score OF 85.

Discussion

There are 7 reports in the literature about the Masquelet technique in the foot, with favorable results, mostly with functional restoration in complex cases in the medial column and no reports on the lateral column. In our case, the technique proves to be a viable alternative, achieving functional and structural restitution of the foot.

Evidence level

IV.