Interest of nailing associated with the Masquelet technique in reconstruction of bone defect

Ayouba, G; Lemonne, F.; Kombate, Noufanangue Kanfitine; Bakriga, Batarabadja; Edem, James Yaovi; Max, Uzel André-Pierre

doi:10.1016/j.jor.2019.12.014

Cited by 13 publications

(16 citation statements)

References 13 publications

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“…On the other hand, some surgeons believe infection control should take priority. Thus, based on different concepts treatment protocols mainly include 1) local debridement and antibiotic administration and retaining the nail until after bone union, 2) nail removal, re-reaming, and replacement of a larger diameter intramedullary nail or a resorbable antibiotic coated nail [ 10 , 23 ], and 3) nail removal, segmental bone resection, reaming and irrigation, and bone defect reconstruction with bone transport [ 29 ] or the Masquelet technique [ 30 , 31 ]. We are inclined to a more aggressive treatment protocol, and in our opinion retaining the nail or replacing it with another internal fixation device after debridement is not suitable for infection control, because the residual pathogens and its biofilms might lead a higher potential for infection recurrence and treatment failure [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

Zhang

Zhou

Meng

et al. 2020

BMC Musculoskelet Disord

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Background The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis. Methods We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1 ± 9.4 months (range, 24 to 55 months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively. Conclusion Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.

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Section: Discussionmentioning

confidence: 99%

Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

Zhang

Zhou

Meng

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…On the other hand, some surgeons believe infection control should take priority. Thus, based on different concepts treatment protocols mainly include 1) local debridement and antibiotic administration and retaining the nail until after bone union, 2) nail removal, re-reaming, and replacement of a larger diameter intramedullary nail or a resorbable antibiotic coated nail [12,25], and 3) nail removal, segmental bone resection, reaming and irrigation, and bone defect reconstruction with bone transport [31] or the Masquelet technique [32,33]. We are inclined to a more aggressive treatment protocol, and in our opinion retaining the nail or replacing it with another internal xation device after debridement is not suitable for infection control, because the residual pathogens and its bio lms might lead a higher potential for infection recurrence and treatment failure [6].…”

Section: Discussionmentioning

confidence: 99%

Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

Zhang

Zhou

Meng

et al. 2020

Preprint

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Background: The incidence of intramedullary infection is increasing with increased use of intramedullary fixation for long bone fractures. However, appropriate treatment for infection after intramedullary nailing is unclear. The purpose of this study was to report the results of our treatment protocol for infection after intramedullary nailing: intramedullary nail removal, local debridement, reaming and irrigation, and antibiotic-loaded calcium sulfate implantation with or without segmental bone resection and distraction osteogenesis.Methods: We retrospectively reviewed the records of patients with an infection after intramedullary nailing treated from 2014 to 2017 at our center. Patients with follow-up of less than 24 months, received other treatment methods, or those with serious medical conditions were excluded from the analysis. Patients met the criteria were treated as described above, followed by distraction osteogenesis in 9 cases to repair bone defect. The infection remission rate, infection recurrence rate, and post-operative complication rates were assessed. Results: A total of 19 patients were included in the analysis. All of patients had satisfactory outcomes with an average follow-up of 38.1± 9.4 months (range, 24 to 55months). Eighteen patients (94.7%) achieved infection remission; 1 patient (5.3%) developed a reinfection that resolved after repeat debridement. Nine patients with bone defects (average size 4.7 ± 1.3 cm; range, 3.3 to 7.6 cm) were treated with bone transport which successfully restored the length of involved limb. The mean bone transport duration was 10.7 ± 4.0 months (range, 6.7 to 19.5 months). The majority of patients achieved full weight bearing and became pain free during the follow-up period. Postoperative complications mainly included prolonged aseptic drainage (7/19; 36.8%), re-fracture (1/19; 5.3%) and joint stiffness, which were successfully managed by regular dressing changes and re-fixation, respectively.Conclusion: Intramedullary nail removal, canal reaming and irrigation, and antibiotic-loaded calcium sulfate implantation (with or without distraction osteogenesis) is effective for treating infections after intramedullary nailing.

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“…Preoperative and post-operative radiographs for each patient are shown in (Fig. 1,2,3,4,5,6). Intraoperative images from patient 2 are shown in (Fig.…”

Section: All Of These Approaches and Combinations Of Techniques Attemptmentioning

confidence: 99%

“…After stabilization of the patient and once the site of injury is acceptable for definitive skeletal reconstruction and fixation, critical bone loss presents a dilemma in and of itself. No consensus has been approached in terms of management of these bone defects [ 1 , 2 , 3 , 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Use of Tantalum Trabecular Metal Cones for Management of Nonunion of the Distal Femur with Segmental Bone Defects: Technique and Case Series

Reynolds

Melvin

Yakish

et al. 2021

JOCR

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Introduction: Segmental bone loss in the distal femur presents a challenge for reconstruction regardless of etiology. Use of tantalum trabecular metal cones with intramedullary fixation and autologous bone graft may be used as a salvage technique in difficult situations where other options have either been exhausted or are unavailable. Case Report: Surgical planning and technique for this approach to reconstruction are described. A retrospective review of five cases with >1 year of follow-up was performed to provide radiographic and clinical outcomes. All five patients had satisfactory outcomes with clinical union and retention of implants at final follow-up (average >4 years). Conclusions: Use of tantalum metal cones for reconstruction of distal femur nonunion with segmental bone defects can be a successful technique in a complex group of patients. Keywords: Femur, bone defect, non-union, induced membrane, tantalum.

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Interest of nailing associated with the Masquelet technique in reconstruction of bone defect

Cited by 13 publications

References 13 publications

Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

Intramedullary reaming and irrigation and antibiotic-loaded calcium sulfate implantation for the treatment of infection after intramedullary nailing: a retrospective study of 19 cases

Use of Tantalum Trabecular Metal Cones for Management of Nonunion of the Distal Femur with Segmental Bone Defects: Technique and Case Series

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