Management of infected bone defects of the femoral shaft by Masquelet technique: sequential internal fixation and nail with plate augmentation.
Humans
Male
Retrospective Studies
Female
Adult
Bone Plates
Femoral Fractures
/ surgery
Middle Aged
Debridement
/ methods
Bone Nails
Fracture Fixation, Intramedullary
/ methods
Young Adult
Treatment Outcome
Bone Transplantation
/ methods
Fracture Fixation, Internal
/ methods
Follow-Up Studies
Bone Cements
/ therapeutic use
Anti-Bacterial Agents
/ therapeutic use
Femur
/ surgery
Adolescent
Chronic osteomyelitis
Femur, bone defect
Internal fixation
Masquelet technique
Plate augmentation
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
17 Jul 2024
17 Jul 2024
Historique:
received:
12
02
2024
accepted:
09
07
2024
medline:
17
7
2024
pubmed:
17
7
2024
entrez:
16
7
2024
Statut:
epublish
Résumé
To evaluate the effectiveness of a sequential internal fixation strategy and intramedullary nailing with plate augmentation (IMN/PA) for bone reconstruction in the management of infected femoral shaft defects using the Masquelet technique. We performed a retrospective descriptive cohort study of 21 patients (mean age, 36.4 years) with infected bone defects of the femoral shaft treated by the Masquelet technique with a minimum follow-up of 18 months after second stage. After aggressive debridement, temporary stabilisation (T1) was achieved by an antibiotic-loaded bone cement spacer and internal fixation with a bone cement-coated locking plate. At second stage (T2), the spacer and the locking plate were removed following re-debridement, and IMN/PA was used as definitive fixation together with bone grafting. We evaluated the following clinical outcomes: infection recurrence, bone union time, complications, and the affected limb's knee joint function. The median and quartiles of bone defect length was 7 (4.75-9.5) cm. Four patients required iterative debridement for infection recurrence after T1. The median of interval between T1 and T2 was 10 (9-19) weeks. At a median follow-up of 22 (20-27.5) months, none of the patients experienced recurrence of infection. Bone union was achieved at 7 (6-8.5) months in all patients, with one patient experiencing delayed union at the distal end of bone defect due to screws loosening. At the last follow-up, the median of flexion ROM of the knee joint was 120 (105-120.0)°. For infected femoral shaft bone defects treated by the Masquelet technique, sequential internal fixation and IMN/PA for the reconstruction can provide excellent mechanical stability, which is beneficial for early functional exercise and bone union, and does not increase the rate of infection recurrence.
Sections du résumé
BACKGROUND
BACKGROUND
To evaluate the effectiveness of a sequential internal fixation strategy and intramedullary nailing with plate augmentation (IMN/PA) for bone reconstruction in the management of infected femoral shaft defects using the Masquelet technique.
METHODS
METHODS
We performed a retrospective descriptive cohort study of 21 patients (mean age, 36.4 years) with infected bone defects of the femoral shaft treated by the Masquelet technique with a minimum follow-up of 18 months after second stage. After aggressive debridement, temporary stabilisation (T1) was achieved by an antibiotic-loaded bone cement spacer and internal fixation with a bone cement-coated locking plate. At second stage (T2), the spacer and the locking plate were removed following re-debridement, and IMN/PA was used as definitive fixation together with bone grafting. We evaluated the following clinical outcomes: infection recurrence, bone union time, complications, and the affected limb's knee joint function.
RESULTS
RESULTS
The median and quartiles of bone defect length was 7 (4.75-9.5) cm. Four patients required iterative debridement for infection recurrence after T1. The median of interval between T1 and T2 was 10 (9-19) weeks. At a median follow-up of 22 (20-27.5) months, none of the patients experienced recurrence of infection. Bone union was achieved at 7 (6-8.5) months in all patients, with one patient experiencing delayed union at the distal end of bone defect due to screws loosening. At the last follow-up, the median of flexion ROM of the knee joint was 120 (105-120.0)°.
CONCLUSIONS
CONCLUSIONS
For infected femoral shaft bone defects treated by the Masquelet technique, sequential internal fixation and IMN/PA for the reconstruction can provide excellent mechanical stability, which is beneficial for early functional exercise and bone union, and does not increase the rate of infection recurrence.
Identifiants
pubmed: 39014409
doi: 10.1186/s12891-024-07681-x
pii: 10.1186/s12891-024-07681-x
doi:
Substances chimiques
Bone Cements
0
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
552Subventions
Organisme : the Applied Basic Research Joint Project of Yunnan Science and Technology Department and Kunming Medical University
ID : 202101AY070001-294
Organisme : the Applied Basic Research Joint Project of Yunnan Science and Technology Department and Kunming Medical University
ID : 202101AY070001-294
Organisme : the Applied Basic Research Joint Project of Yunnan Science and Technology Department and Kunming Medical University
ID : 202101AY070001-294
Organisme : Yunnan Orthopaedics and Sports Rehabilitation Clinical Medicine Research Centre
ID : 202102AA310068
Organisme : Yunnan Orthopaedics and Sports Rehabilitation Clinical Medicine Research Centre
ID : 202102AA310068
Organisme : Yunnan Orthopaedics and Sports Rehabilitation Clinical Medicine Research Centre
ID : 202102AA310068
Organisme : Yunnan Orthopaedics and Sports Rehabilitation Clinical Medicine Research Centre
ID : 202102AA310068
Organisme : Yunnan Provincial Clinical Orthopaedic Trauma Medical Centre
ID : ZX20191001
Organisme : Yunnan Provincial Clinical Orthopaedic Trauma Medical Centre
ID : ZX20191001
Informations de copyright
© 2024. The Author(s).
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