Surgical Treatment for Infected Long Bone Defects After Limb-Threatening Trauma: Application of Locked Plate and Autogenous Cancellous Bone Graft

Abstract

Background : Treatment strategies for bone defects include free bone grafting, distraction osteogenesis, and vascularized bone grafting. Because bone defect morphology is often irregular, selecting treatment strategies may be difficult. With the Masquelet technique, a fracture site is bridged and fixed with a locking plate after treating deep infection with antibiotic -containing cement, and a free cancellous bone -graft is concomitantly placed into the defects. This procedure avoids excessive bone resection. Methods : We studied 6 patients who underwent surgical treatment for deep infection occurring after extremity trauma (2004 through In all patients, bone defects were filled with antibiotic -containing cement beads after infected site debridement. If bacterial culture of infected sites during curettage was positive, surgery was repeated to refill bone defects with antibiotic -containing cement beads. After confirmation of negative bacterial culture, osteosynthesis was performed, in which bone defects were bridged and fixed with locking plates. Concomitantly, crushed cancellous bone grafts harvested from the autogenous ilium was placed in the bone defects. Results : Time from bone grafting and plate fixation to bone union was at least 3 and at most 6 months, 4 months on average. Infection relapsed in one patient with methicillin -resistant Staphylococcus aureus, necessitating vascularized fibular grafting which achieved bone union. No patients showed implant loosening or breakage or infection relapse after the last surgery during follow -up. Conclusion : The advantage of cancellous bone grafting include applicability to relatively large bone defects, simple surgical procedure, bone graft adjustability to bone defect morphology, rapid bone graft revascularization resulting in high resistance to infection, and excellent osteogenesis.

Treatment of Posttraumatic Tibial Diaphyseal Bone Defects: A Systematic Review and Meta-Analysis

“…Included studies were published from 1985 through 2020. Patients with tibial diaphyseal bone defects (n = 826) were treated with NBGs (studies = 44, n = 335), 6–49 BT (studies = 35, n = 298), 6,14,19,23,35,46,49–77 or VBGs (studies = 41, n = 193). 41,60,67,75,78–114…”

Reconstruction of a post-traumatic tibial defect of 10 cm in a 6 month old induced membrane by non-vascularised fibula autograft – A case report

“…Donegan [7] used vascularised fibula in one case out of 11 which was sarcoma patient with post irradiation bone defect. Kawakami [8] used only one vascularised fibula out of six cases in forearm fracture with MRSA infection. There is no mention of non vascularised fibula graft use in published literature.…”

Masquelet technique for infected distal radius fractures with gaps in paediatric age group

“…We have used a vancomycin impregnated cement spacer to fill the bone gap to deliver adequate concentration of local antibiotic and also to stimulate an induce membrane, which would promote osteogenesis. Kawakami et al successfully used cement beads instead of spacer for the same purpose [8] . Luo et al used gentamycin impregnated cement, and 2 patients suffered reinfection [9] .…”