Treatment of Post-traumatic Bone Defects with infection in long bones
DOI:
https://doi.org/10.21276/tq58pz04Keywords:
Antibiotic cement spacer, induced biomembrane bone grafting, management of bone defect, management of compound fractures, Masquelet techniqueAbstract
Introduction: Open fractures are a challenging condition to treat because they are frequently compounded by infection and nonunion. Traditional bone defect care strategies are mostly focused on fracture union rather than infection prevention. The goal of this study is to use the Masquelet approach to examine the outcome of a post-traumatic defect with infection in long bones. This method is a two-step process. Stage I surgery includes debridement and the placement of an antibacterial spacer in the bone defect. Stage II surgery involved removing the spacer while preserving the induced membrane that had grown on the spacer's surface and filling the bone-gap with morselized iliac crest bone-graft within the membrane sleeve.
Materials and Methods: There were 22 patients in this study (18 males and 4 females), all of them had infected long bone fractures with a bone defect. The average length of the bone defect was 3.5 centimetres. The duration of follow-up varied from 6 to 15 months.
Results: After an average of 11.5 weeks following the first step of surgery, radiological union was achieved. After stage 1, no patient had any remaining infection. After radiological union, all of the patients were able to mobilise with full weight bearing and a satisfactory range of motion in the adjoining joints.
Conclusion: With favourable outcomes, this treatment can be used on infected fractures with bone loss on a regular basis. Antibiotic cement spacers, used in conjunction with complete debridement, minimise the risk of infection. The graft is revascularized through induced biomembrane. In most circumstances, union may be predicted; nonetheless, the length of time it takes to reach an agreement is a constraint. The technique is low-cost and does not necessitate any additional training or equipment. Despite the fact that it is a two-stage procedure, it does not necessitate several surgeries as in traditional approaches.
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A. Paige Whittle, “Fractures of the Lower Extremity,” In: S. Terry Canale and H. B. James, Eds., Campbell’s Operative Orthopaedics, Mosby, Philadelphia, 2008, pp. 3117-3146. [Citation Time(s):2]
J. T. Watson, M. Anders, and B. R. Moed, “Management strategies for bone loss in tibial shaft fractures,” Clinical Orthopaedics and Related Research, no. 315, pp. 138–152, 1995
H. Weinberg, V. G. Roth, G. C. Robin, and Y. Floman, “Early fibular bypass procedures (tibiofibular synostosis) for massive bone loss in war injuries,” Journal of Trauma, vol. 19, no. 3, pp. 177–181, 1979.
R. Hertel, A. Gerber, U. Schlegel, J. Cordey, P. Ruegsegger, and B. A. Rahn, “Cancellous bone graft for skeletal reconstruction: muscular versus periosteal bed—preliminary report,” Injury, vol. 25, supplement 1, pp. A59–A70, 1994.
A. C. Masquelet, “Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction,” Langenbeck's Archives of Surgery, vol. 388, no. 5, pp. 344–346, 2003.
A. C. Masquelet and T. Begue, “The concept of induced membrane for reconstruction of long bone defects,” Orthopedic Clinics of North America, vol. 41, no. 1, pp. 27–37, 2010.
A. C. Masquelet, F. Fitoussi, T. Begue, and G. P. Muller, “Reconstruction of the long bones by the induced membrane and spongy autograft,” Annales de Chirurgie Plastique et Esthetique, vol. 45, no. 3, pp. 346–353, 2000.
T. A. McCall, D. S. Brokaw, B. A. Jelen et al., “Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series,” Orthopedic Clinics of North America, vol. 41, no. 1, pp. 63–73, 2010
C. Y.-L. Woon, K.-W. Chong, and M.-K. Wong, “Induced membranes—a staged technique of bone-grafting for segmental bone loss. A report of two cases and a literature review,” The Journal of Bone and Joint Surgery. American, vol. 92, no. 1, pp. 196–201, 2010.
P. Pelissier, A. C. Masquelet, R. Bareille, S. M. Pelissier, and J. Amedee, “Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration,” Journal of Orthopaedic Research, vol. 22, no. 1, pp. 73–79, 2004.
V. Viateau, G. Guillemin, Y. Calando et al., “Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: an ovine model,” Veterinary Surgery, vol. 35, no. 5, pp. 445–452, 2006.
O. M. Aho, P. Lehenkari, J. Ristiniemi, S. Lehtonen, J. Risteli, and H. V. Leskela, “The mechanism of action of induced membranes in bone repair,” The Journal of Bone and Joint Surgery. American, vol. 95, no. 7, pp. 597–604, 2013.
D. J. Biau, S. Pannier, A. C. Masquelet, and C. Glorion, “Case report: reconstruction of a 16-cm diaphyseal defect after Ewing's resection in a child,” Clinical Orthopaedics and Related Research, vol. 467, no. 2, pp. 572–577, 2009.
F. Accadbled, P. Mazeau, F. Chotel, J. Cottalorda, J. Sales de Gauzy, and R. Kohler, “Induced-membrane femur reconstruction after resection of bone malignancies: three cases of massive graft resorption in children,” Orthopaedics & Traumatology, Surgery & Research, vol. 99, no. 4, pp. 479–483, 2013.
N. T. O'Malley and S. L. Kates, “Advances on the Masquelet technique using a cage and nail construct,” Archives of Orthopaedic and Trauma Surgery, vol. 132, no. 2, pp. 245–248, 2012.
L. K. Huffman, J. G. Harris, and M. Suk, “Using the bi-masquelet technique and reamer-irrigator-aspirator for post-traumatic foot reconstruction,” Foot and Ankle International, vol. 30, no. 9, pp. 895–899, 2009.
T. Apard, N. Bigorre, P. Cronier, F. Duteille, P. Bizot, and P. Massin, “Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing,” Orthopaedics and Traumatology: Surgery and Research, vol. 96, no. 5, pp. 549–553, 2010.
G. Schmidmaier, S. Herrmann, J. Green et al., “Quantitative assessment of growth factors in reaming aspirate, iliac crest, and platelet preparation,” Bone, vol. 39, no. 5, pp. 1156–1163, 2006
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