En bloc resection combined with induced membrane technique for treatment of Cierny-Mader type IV posttraumatic long bone infection

Abstract

Objective To investigate the results of Cierny-Mader type Ⅳ posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique. Methods A retrospective case series analysis was made on 36 patients with posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique from January 2013 to January 2015. There were 30 male and 6 female patients between 21 and 68 years (mean, 41 years). Infection control, bone union, function activity and complications were detected after operation. Results After debridement in the first stage, a segmental bone defect of 5.5 cm in length (range, 2-10.9 cm) was seen in all patients. Seven patients needed a local flap transfer to cover the wound and five patients had a second debridement. Mean duration of systemic antibiotic use was 2 weeks (range, 1-6 weeks) and mean time interval of second-stage bone grafting was 12 weeks after debridement (range, 6-36 weeks). Mean follow-up was 29.5 months (range, 24-45 months). One patient had recurrence and was cured with radical debridement and a permanent acrylic spacers insertion, with the cure rate of bone infection of 97% (35/36). All patients achieved bone union with a mean duration of 5.9 months (range, 4-8 months), and were able to walk independently. Thirty patients returned to work or pre-operative physical labor. No pain and re-fracture occurred. Six patients had adjacent joint stiffness. Conclusion En bloc resection combined with induced membrane technique is associated with radical debridement, decreased recurrence rate and limb salvage, indicating a simple and effective method for Cierny-Mader type IV posttraumatic long bone infection. Key words: Osteomyelitis; Fractures, bone; Induced membrane technique