Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series

Abstract

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.

Masquelet technique in management of infective non-union of long bones- A prospective study

“…The membrane is carefully dissected from bone cement and it is closed after application of bone graft. Kasha et al, in their study, have proved that the membrane avoided the resorption of cancellous bone graft and had a positive impact on healing of autograft (6). In our study, 7 patients had deficient membrane and subsequently converted to Ilizarov technique.…”

“…The average duration of healing in our study was 8 months. Kasha et al, also stated that the best period to perform bone grafting is after 1 month of cement application due to highest level of BMP-2 (Bone Morphogenetic Protein) secretion by the end of 4 th week (6). In our study, we monitored ESR and CRP weekly and it took 6-8 weeks for the inflammatory markers to come down.…”

“…Ilizarov bone transport, vascularised bone graft, Limb Reconstructive System are used with varying success rates. All of these methods, technically do not function against infection (6). A novel method, has been developed by Masquelet which utilises body's natural foreign body response and regenerative capabilities (7).…”

Antibiotic Cement Utilization for the Prophylaxis and Treatment of Infections in Spine Surgery: Basic Science Principles and Rationale for Clinical Use

“…ABC has been shown to be efficacious for the prophylaxis and treatment of surgical site infections (SSI), particularly in the orthopedic subspecialities of arthroplasty and trauma [ 1 , 2 , 3 , 4 ]. In hip and knee arthroplasties, ABC prevents infection 90% more effectively than normal bone cement [ 5 ].…”

Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in the Management of Patients With Traumatic Bone Voids

“…Over the years, traumatic bone voids have continued to be a challenge for orthopaedic surgeons. In patients with fractures, bone loss can happen at the time of injury or during surgical debridement of devitalised bone fragments [ 1 , 2 ]. If not managed appropriately, residual voids can subsequently be occupied with fluid (or blood), creating a rich medium for infective microorganisms to flourish and proliferate, increasing the risk of deep infection [ 3 ].…”