Comparison of internal and external fixation after debridement in the Masquelet technique for Cierny-Mader type IV tibial post-traumatic osteomyelitis

Zhang, Hu; Zhao, Xian-Geng; Yang, Xiaoyong; Zhang, Xijiao; Chen, Xingyu; Zhou, Tianhua; Xu, Xun; Song, Muguo; Luo, Shunji; Xie, Zhiyong; Xu, Yongqing; Shi, Jian

doi:10.1016/j.injury.2022.11.030

Cited by 9 publications

(7 citation statements)

References 38 publications

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“…30 The traditional view is that internal fixation after infection debridement increases the rate of infection recurrence. 35 However, our team’s previous reports, 36,37 and others’ comparative studies, 38,39 confirmed that antibiotic cement-coated locking plate internal fixation had the same effect on controlling infection as external fixation, which is consistent with our multivariate analysis. Additional attention should also be given to redebridement during second-stage operations.…”

Section: Discussionsupporting

confidence: 87%

The induced membrane technique for the management of infected segmental bone defects

Shen,

Wei,

et al. 2024

Bone Joint J

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AimsThe aim of the present study was to assess the outcomes of the induced membrane technique (IMT) for the management of infected segmental bone defects, and to analyze predictive factors associated with unfavourable outcomes.MethodsBetween May 2012 and December 2020, 203 patients with infected segmental bone defects treated with the IMT were enrolled. The digital medical records of these patients were retrospectively analyzed. Factors associated with unfavourable outcomes were identified through logistic regression analysis.ResultsAmong the 203 enrolled patients, infection recurred in 27 patients (13.3%) after bone grafting. The union rate was 75.9% (154 patients) after second-stage surgery without additional procedures, and final union was achieved in 173 patients (85.2%) after second-stage surgery with or without additional procedures. The mean healing time was 9.3 months (3 to 37). Multivariate logistic regression analysis of 203 patients showed that the number (≥ two) of debridements (first stage) was an independent risk factor for infection recurrence and nonunion. Larger defect sizes were associated with higher odds of nonunion. After excluding 27 patients with infection recurrence, multivariate analysis of the remaining 176 patients suggested that intramedullary nail plus plate internal fixation, smoking, and an allograft-to-autograft ratio exceeding 1:3 adversely affected healing time.ConclusionThe IMT is an effective method to achieve infection eradication and union in the management of infected segmental bone defects. Our study identified several risk factors associated with unfavourable outcomes. Some of these factors are modifiable, and the risk of adverse outcomes can be reduced by adopting targeted interventions or strategies. Surgeons can fully inform patients with non-modifiable risk factors preoperatively, and may even use other methods for bone defect reconstruction.Cite this article: Bone Joint J 2024;106-B(6):613–622.

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Section: Discussionsupporting

confidence: 87%

The induced membrane technique for the management of infected segmental bone defects

Shen,

Wei,

et al. 2024

Bone Joint J

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“…The method of stability after debridement of infected bone defects in the T1 stage includes external and internal fixation. The choice depends on the site of the defect [ 19 ]. For femoral shaft defects, both options are available.…”

Section: Discussionmentioning

confidence: 99%

“…The routine surgical protocol of the Masquelet technique was similar to that previously reported by our institution [ 19 ]. At T1 stage, aggressive debridement, fixation with a locking plate coated with Vancomycin (Eli Lilly, Tokyo, Japan)-loaded PMMA cement (Palacos ® R + G, Heraeus, Germany) and subsequent filling of the bone defect with cement was performed.…”

Section: Methodsmentioning

confidence: 99%

Management of infected bone defects of the femoral shaft by Masquelet technique: sequential internal fixation and nail with plate augmentation

Yang,

Xu,

et al. 2024

BMC Musculoskelet Disord

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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 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 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 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.

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“…Osteomyelitis refers to a common orthopedic disease occurring in bone tissue infected with pathogenic microorganisms, and generally consists of acute osteomyelitis and chronic osteomyelitis. Approximately 10%-30% of acute osteomyelitis can progress to chronic osteomyelitis [1][2][3]. Besides, according to its pathogenesis, osteomyelitis is divided into hematogenous and traumatic osteomyelitis.…”

Section: Introductionmentioning

confidence: 99%

Clinical Features of Chronic Tibial Osteomyelitis: A Single-center Retrospective Study of 282 Cases in Xinjiang, China

Huang,

Chen,

et al. 2024

Preprint

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Objective:This study aims to provide theoretical basis for treatment and prevention of osteomyelitis by investigating and analyzing clinical features and pathogen distribution among 282 patients with chronic tibial osteomyelitis. Methods:A total of 282 patients with chronic tibial osteomyelitis from January 1, 2012 to January 1, 2022 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. All data were collected from electronic medical record (EMR) system including demographics, etiology, risk factors, osteomyelitis location and clinical classification. Results:Farmers, students, unemployed and retirees accounted for a relatively large proportion of the 282 patients. There were 233 males and 49 females with a gender ratio of 4.75:1. The average age was 40.21±15.68 years and was mainly concentrated in 41-50 years, specifically, the mean age of females was slightly older than that of males. Education level was mostly primary and secondary school education, and illiteracy. Risk factors of chronic tibial osteomyelitis included history of smoking and drinking, history of multiple repeated surgeries, and impaired immunity. Frequent clinical symptoms were in the order of pain, local swelling,pus discharge and skin ulceration. Among all inflammatory markers, proportion of positive results were 30.85%, 59.93% and 53.90% for white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), respectively. Positive rate of pathogenic microorganism culture was low and the three most common bacteria were Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa) and Escherichia coli (E. coli). The most frequent site of infection was middle tibia. According to Cierny-Mader osteomyelitis classification, the most common types were type IIIA, IVA and IIA. Conclusion:Number of visits due to chronic osteomyelitis increased year by year, with young and middle-aged male farmers and low education level as the main groups. Smoking and drinking were two considerable risk factors that should be attached to a great importance. No significant increase was found in inflammatory markers and lower positive rate of pathogenic microorganism culturewas observed. Multi-drug resistant bacteria were common and S. aureus remained the most frequent pathogen. Elevated ESR had certain diagnostic value for osteomyelitis. Type III and type IV osteomyelitis accounted for a large proportion which posed great challenges for clinical diagnosis and treatment.

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Comparison of internal and external fixation after debridement in the Masquelet technique for Cierny-Mader type IV tibial post-traumatic osteomyelitis

Cited by 9 publications

References 38 publications

The induced membrane technique for the management of infected segmental bone defects

The induced membrane technique for the management of infected segmental bone defects

Management of infected bone defects of the femoral shaft by Masquelet technique: sequential internal fixation and nail with plate augmentation

Clinical Features of Chronic Tibial Osteomyelitis: A Single-center Retrospective Study of 282 Cases in Xinjiang, China

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