Lesion clearance combined with Ilizarov technique for treatment of tophi in first metatarsophalangeal joint with bone defect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Boquan ¹ , WU Shizhou ¹ , XIE Huiqi ² , HUANG Fuguo ³ ,  ZHANG Hui ³

1. West China School of Medicine, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
3. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

ZHANG Hui, Email: caesarzh@163.com

Keywords：

Tophi; first metatarsophalangeal joint; bone defect; Ilizarov technique; lesion clearance

DOI：

10.7507/1002-1892.201907063

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the effectiveness of lesion clearance combined with Ilizarov technique for the treatment of tophi in first metatarsophalangeal (MTP) joint with bone defect.Methods Between July 2016 and June 2018, 14 cases of tophi in the first MTP joint with bone defect were treated by lesion clearance combined with Ilizarov technique. There were 12 males and 2 females. The average age was 39.3 years (range, 22-60 years). The disease duration ranged from 5 to 15 years, with an average of 11.2 years. The tophi volume ranged from 2.5 cm×2.7 cm×2.2 cm to 5.2 cm×2.9 cm×2.4 cm. The X-ray films showed that the length of the bone defect ranged from 2.0 to 4.6 cm, with an average of 3.4 cm. Preoperative visual analogue scale (VAS) score was 7.6±0.9; American Orthopaedic Foot and Ankle Society (AOFAS) score was 47.5±4.3; short-form 36 health survey scale (SF-36) score was 79.7±4.7.Results The incision primarily healed in 13 patients after operation. The skin necrosis at the edge of the incision occurred in 1 patient and recovered after symptomatic treatment. All 14 patients were followed up 12-16 months, with an average of 13.6 months. X-ray films showed that the first metatarsal column defects were repaired. The time of bone extension ranged from 2 to 6 weeks, with an average of 3.6 weeks. The time of bone healing ranged from 9 to 16 weeks, with an average of 11.2 weeks. During follow-up, no complication such as nerve, blood vessel, or tendon injury, needle tract infection, or stress fracture occurred. At last follow-up, VAS score was 1.4±0.5, AOFAS score was 86.6±4.8, and SF-36 score was 89.1±3.3, all of which were superior to preoperative scores, with significant differences (t=22.532, P=0.000; t=22.702, P=0.000; t=6.124, P=0.000).Conclusion Lesion clearance combined with Ilizarov technique is a safe and effective method for the treatment of tophi in the first MTP joint with bone defect.

Citation： QIN Boquan, WU Shizhou, XIE Huiqi, HUANG Fuguo, ZHANG Hui. Lesion clearance combined with Ilizarov technique for treatment of tophi in first metatarsophalangeal joint with bone defect. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(2): 168-172. doi: 10.7507/1002-1892.201907063 Copy

1.	Richette P, Bardin T. Gout. Lancet, 2010, 375(9711): 318-328.
2.	Kang MH, Moon KW, Jeon YH, et al. Sonography of the first metatarsophalangeal joint and sonographically guided intraarticular injection of corticosteroid in acute gout attack. J Clin Ultrasound, 2015, 43(3): 179-186.
3.	Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken), 2012, 64(10): 1431-1446.
4.	Larmon WA. Surgical management of tophaceous gout. Clin Orthop Relat Res, 1970, 71: 56-69.
5.	Lee SS, Lin SD, Lai CS, et al. The soft-tissue shaving procedure for deformity management of chronic tophaceous gout. Ann Plast Surg, 2003, 51(4): 372-375.
6.	Wang CC, Lien SB, Huang GS, et al. Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout. Arthroscopy, 2009, 25(2): 153-158.
7.	Barg A, Kunpp M, Kapron AL, et al. Total ankle replacement in patients with gouty arthritis. J Bone Joint Surg (Am), 2011, 93(4): 357-366.
8.	Kim YS, Park EH, Lee HJ, et al. First metatarsophalangeal joint arthrodesis for the treatment of tophaceous gouty arthritis. Orthopedics, 2014, 37(2): e141-e147.
9.	张占磊, 白波, 董伟强, 等. 第一跖趾关节痛风石的手术治疗. 中华关节外科杂志 (电子版), 2013, 7(3): 358-362.
10.	Liu F, Huang RK, Xie M, et al. Use of Masquelet’s technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect. Foot Ankle Surg, 2018, 24(2): 159-163.
11.	Stapleton JJ, Rodriguez RH, Jeffries LC, et al. Salvage of the first ray with concomitant septic and gouty arthritis by use of a bone block joint distraction arthrodesis and external fixation. Clin Podiatr Med Surg, 2008, 25(4): 755-762.
12.	Kasper IR, Juriga MD, Giurini JM, et al. Treatment of tophaceous gout: When medication is not enough. Semin Arthritis Rheum, 2016, 45(6): 669-674.
13.	Schlesinger N, Thiele RG. The pathogenesis of bone erosions in gouty arthritis. Ann Rheum Dis, 2010, 69(11): 1907-1912.
14.	Chhana A, Callon KE, Pool B, et al. Monosodium urate monohydrate crystals inhibit osteoblast viability and function: implications for development of bone erosion in gout. Ann Rheum Dis, 2011, 70(9): 1684-1691.
15.	Scher DM, Blyakher A, Krantzow M. A modified surgical technique for lengthening of a metatarsal using an external fixator. HSS J, 2010, 6(2): 235-239.
16.	Giannini S, Faldini C, Pagkrati S, et al. One-stage metatarsal lengthening by allograft interposition: a novel approach for congenital brachymetatarsia. Clin Orthop Relat Res, 2010, 468(7): 1933-1942.
17.	郭保逢, 赵巍, 徐执扬, 等. 无植骨 Ilizarov 外固定技术治疗股骨萎缩性骨不连. 中国修复重建外科杂志, 2019, 33(8): 940-946.
18.	张磊, 王新卫, 陈雨声, 等. 应用 Ilizarov 技术治疗骨髓炎出现复杂软组织问题的处理技巧探讨. 中国修复重建外科杂志, 2018, 32(10): 1286-1291.
19.	Lee KB, Yang HK, Chung JY, et al. How to avoid complications of distraction osteogenesis for first brachymetatarsia. Acta Orthop, 2009, 80(2): 220-225.
20.	杨华清, 彭爱民, 韩庆海, 等. 微创截骨 Ilizarov 骨延长术治疗先天性跖骨短小症. 足踝外科电子杂志, 2017, 4(1): 25-29.
21.	Kumar S, Gow P. A survey of indications, results and complications of surgery for tophaceous gout. N Z Med J, 2002, 115(1158): U109.

1. Richette P, Bardin T. Gout. Lancet, 2010, 375(9711): 318-328.
2. Kang MH, Moon KW, Jeon YH, et al. Sonography of the first metatarsophalangeal joint and sonographically guided intraarticular injection of corticosteroid in acute gout attack. J Clin Ultrasound, 2015, 43(3): 179-186.
3. Khanna D, Fitzgerald JD, Khanna PP, et al. 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. Arthritis Care Res (Hoboken), 2012, 64(10): 1431-1446.
4. Larmon WA. Surgical management of tophaceous gout. Clin Orthop Relat Res, 1970, 71: 56-69.
5. Lee SS, Lin SD, Lai CS, et al. The soft-tissue shaving procedure for deformity management of chronic tophaceous gout. Ann Plast Surg, 2003, 51(4): 372-375.
6. Wang CC, Lien SB, Huang GS, et al. Arthroscopic elimination of monosodium urate deposition of the first metatarsophalangeal joint reduces the recurrence of gout. Arthroscopy, 2009, 25(2): 153-158.
7. Barg A, Kunpp M, Kapron AL, et al. Total ankle replacement in patients with gouty arthritis. J Bone Joint Surg (Am), 2011, 93(4): 357-366.
8. Kim YS, Park EH, Lee HJ, et al. First metatarsophalangeal joint arthrodesis for the treatment of tophaceous gouty arthritis. Orthopedics, 2014, 37(2): e141-e147.
9. 张占磊, 白波, 董伟强, 等. 第一跖趾关节痛风石的手术治疗. 中华关节外科杂志 (电子版), 2013, 7(3): 358-362.
10. Liu F, Huang RK, Xie M, et al. Use of Masquelet’s technique for treating the first metatarsophalangeal joint in cases of gout combined with a massive bone defect. Foot Ankle Surg, 2018, 24(2): 159-163.
11. Stapleton JJ, Rodriguez RH, Jeffries LC, et al. Salvage of the first ray with concomitant septic and gouty arthritis by use of a bone block joint distraction arthrodesis and external fixation. Clin Podiatr Med Surg, 2008, 25(4): 755-762.
12. Kasper IR, Juriga MD, Giurini JM, et al. Treatment of tophaceous gout: When medication is not enough. Semin Arthritis Rheum, 2016, 45(6): 669-674.
13. Schlesinger N, Thiele RG. The pathogenesis of bone erosions in gouty arthritis. Ann Rheum Dis, 2010, 69(11): 1907-1912.
14. Chhana A, Callon KE, Pool B, et al. Monosodium urate monohydrate crystals inhibit osteoblast viability and function: implications for development of bone erosion in gout. Ann Rheum Dis, 2011, 70(9): 1684-1691.
15. Scher DM, Blyakher A, Krantzow M. A modified surgical technique for lengthening of a metatarsal using an external fixator. HSS J, 2010, 6(2): 235-239.
16. Giannini S, Faldini C, Pagkrati S, et al. One-stage metatarsal lengthening by allograft interposition: a novel approach for congenital brachymetatarsia. Clin Orthop Relat Res, 2010, 468(7): 1933-1942.
17. 郭保逢, 赵巍, 徐执扬, 等. 无植骨 Ilizarov 外固定技术治疗股骨萎缩性骨不连. 中国修复重建外科杂志, 2019, 33(8): 940-946.
18. 张磊, 王新卫, 陈雨声, 等. 应用 Ilizarov 技术治疗骨髓炎出现复杂软组织问题的处理技巧探讨. 中国修复重建外科杂志, 2018, 32(10): 1286-1291.
19. Lee KB, Yang HK, Chung JY, et al. How to avoid complications of distraction osteogenesis for first brachymetatarsia. Acta Orthop, 2009, 80(2): 220-225.
20. 杨华清, 彭爱民, 韩庆海, 等. 微创截骨 Ilizarov 骨延长术治疗先天性跖骨短小症. 足踝外科电子杂志, 2017, 4(1): 25-29.
21. Kumar S, Gow P. A survey of indications, results and complications of surgery for tophaceous gout. N Z Med J, 2002, 115(1158): U109.

Chinese Journal of Reparative and Reconstructive Surgery

Lesion clearance combined with Ilizarov technique for treatment of tophi in first metatarsophalangeal joint with bone defect

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content