Transient bone resorption following finger replantation: a report of 3 cases

Abstract

【Abstract】Radiographic changes consisting of al- terations in mineral content, osteopaenia or destructive neu- ropathy that occur following successful finger replantation have already been described. We report our experience about four fingers in three individuals in whom bone changes de- veloped in the first three months postoperatively with com- plete “restitution ad integrum”. Three patients, 21-49 years old (average 36 years) sus- tained a clean-cut amputation of four fingers. The first pa- tient had an amputation at the base of the middle phalanx of the index finger and the second patient at the base of the proximal phalanx of the ring finger. The third had an ampu- tation at the base of the first metacarpal bone and the proxi- mal phalanx of the small finger in a five finger amputation. In the first case, two dorsal veins and two palmar digital arter- ies and nerves were repaired. In the second case, one pal- mar artery and one dorsal vein were reanastomosed. In the third case at the thumb, two dorsal veins and two palmar digital arteries and nerves were reconstructed. At the small finger, one dorsal vein, one palmar digital artery and two digital nerves were reconstructed. Bone fixation was achieved with two and three K-wires or tension-band wiring. Replantation was successful in all cases. Three weeks after replantation, the X-rays showed rapid development of osteopaenia in the juxtaarticular region and metaphyses of the bone. These changes were followed by subperiosteal, intracortical and endosteal bone resorption. No further sur- gical procedures or splintage were needed and hand therapy was not discontinued. At 10-13 weeks (average 12 weeks) postoperatively, the X-rays showed a complete recovery with new periosteal bone formation. We suggest that the radiographic changes after finger replantation are transient, first evident subperiosteally and progressing centrally. They may reflect small-vessel com- promise and microinfarction and transient hyperemia sec- ondary to neurovascular damage or to sympathetic pro- gressive recovery. Kew words: Fingers; Replantation; Bone resorption