Induced membrane technique combined with antibiotic calcium sulfate pellets in treating infected bone defect in lower extremity

Abstract

Objective To evaluate the clinical effects of the Masquelet technique combined with antibiotic calcium sulfate pellets in treating infected bone defects. Methods From February 2014 to February 2016, 9 patients with infected bone defects were treated in our department, including 7 males and 2 females, with an average age of 37.0 years (range, 24-56 years). 6 cases were infected because of open fractures, 3 infected after internal fixation operation. All defects were located in the lower limb diaphysis and metaphysis (3 cases in femur, 6 cases in tibia). The length of the bone defects were 4-12 cm after debridement, all defects filled with PMMA loaded with Vancomycin, and fixed with external fixators. After 6-10 weeks, the bone cement spacers were taken out and the antibiotic calcium sulfate pellets were implanted into the membrane. A certain amount of autogenous cancellous bone granules would be mixed into the calcium sulfate pellets if the defect was larger than 6-8 cm. 5 cases remained fixed with external fixators, 3 cases replaced for plates, 1 case replaced for plaster external fixator. Regular X-ray follow-ups were taken and complications recorded as well. Evaluate the healing of bone defect and functional recovery of adjacent joints by Samantha X score system, visual analogue scale (VAS) and Paley method, respectively. Results The 9 cases were followed up for a mean duration of 9.3 months (range, 6-15 months). All bone defects healed after a mean time of 14 weeks (range, 10-24 weeks). The wound poor healing occurred in only 1 case in the first stage of surgery, and cured by dressing changes. No complications of the recurrence of infection and implant failure. At the last follow-up, the average Samantha X score was 4.9, the VAS score was 0 to 3 (average 1.5) for patients standing on crutches and all the bone defect healing graded excellent evaluated by Paley method, the functional recovery of the adjacent joints graded: excellent in 6 cases, good in 2 cases, and fair in 1 case (the excellent and good rate was 89%). Conclusion Masquelet technique combined with antibiotic calcium sulfate particles is effective in the treatment of infected bone defects. Key words: Lower extremity; Wounds and injuries; Infection; Anti-bacterial agents; Calcium sulfate