Background:Open fractures are a difficult entity, often complicated by infection and nonunion. Bone loss in such fractures adds to the complexity. Conventional techniques of bone defect management are mainly directed toward fracture union but not against preventing infection or joint stiffness. In this case series, we evaluated Masquelet's technique for management of open fractures with bone loss.Materials and Methods:Twenty seven open fractures with bone defect, which presented within 3 days of trauma were planned for treatment by Masquelet's technique. Followup ranged from 21 to 60 months.Results:Average length of bone defect was 6 cm. Radiological union was obtained at a mean of 280 days since first stage of surgery. Time for union was not related to the size of defect. Union was faster in metaphyseal region (265.6 ± 38.8 days) as compared to diaphysis (300.9 ± 58.6 days). No patient had residual infection after stage 1. All the patients were able to mobilize with full weight bearing after radiological union with a satisfactory range of motion of adjacent joints.Conclusion:This technique can be routinely applied in compound fractures with bone loss with good results. Chances of infection are reduced using antibiotic cement spacer as an adjunct to thorough debridement. Induced biomembrane revascularizes the graft. Union can be expected in most of the cases, however, long time to union is a limitation. Technique is cost-effective and does not require special training or instrumentation. Although it is a two-stage surgery, requirement of multiple surgeries, as may be needed in conventional methods, is avoided.
The general consensus regarding the non-operative management of thoracolumbar (TL) spine fractures revolves around the use of thoracolumbar spine orthosis (TLSO). The efficacy of TLSO bracing remains controversial within the current literature, with several studies showing that prolonged brace use is associated with diminished lung capacity, skin breakdown, and paraspinal muscular atrophy, with no significant difference in pain and functional outcomes between patients treated with or without TLSO.
Extruded bone fragments are a rare complication of high-energy open fractures. Generally, management is thorough debridement and managing the bone defect. In the literature, there are only a few case reports where successful retention of the free bone fragment has been done. Disinfection of bone fragment is done by autoclaving or use of antiseptic/antibiotic solution. Autoclaving leads to complete loss of viable cells and antiseptic/antibiotic solutions do not disinfect completely. In this case report, authors present an innovative technique of disinfecting the bone fragment effectively with minimum compromise on biology.A 38-year-old male with compound grade III B comminuted fracture of distal femur with 2 extruding bone pieces was managed by thorough debridement, external fixator and antibiotic cement spacer. The extruded bone fragments were rinsed in saline and diluted betadine and implanted in subfascial plane in healthy soft tissues in the thigh along with a few antibiotic beads for assuring disinfection. After 1 week, when no clinical signs of infection were found, the site was opened, cement spacer removed, free fragments positioned anatomically and rigid internal fixation was done. Fracture united at 6 months with good functional outcome. At last follow-up at 1 year, the patient was mobilising freely and there were no signs of low grade infection.The key points of this procedure are:Viability of bone fragment maintained while achieving disinfection.Traumatised soft tissues healed and prepared for accepting the free bone fragment.Use of antibiotic cement counters any remaining chances of infection after thorough debridement.Faster union with maintenance of bone length and alignment with use of anatomic fragments.Extensive search of literature was done and this procedure was found to be novel. A larger case series can help in determining the utility of this technique in compound fractures.
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