Maintenance of a cement spacer as definitive treatment of post traumatic osteomyelitis, a case report.

Abstract

Background Septic nonunion is a devastating outcome following a tibial plafond fracture, causing significantly increased morbidity and a lengthy recovery. Treatment options include antibiotics and irrigation and debridement procedures focused on preventing posttraumatic osteomyelitis. If these options fail, surgical intervention is necessary to clear infection and debride nonviable bone, often resulting in a substantial bony void. Masquelet technique and Cement augmentation are well studied, multi-stage procedures designed specifically for combatting these defects. These procedures are associated with significant patient burden, a long non-weight-bearing period, and a lengthy recovery. The case presented here today highlights a variation of these techniques that reduced the need for the standard second stage procedure and resulted in a quicker return to normal activity. Case A 51-year-old obese male presented with a septic nonunion with posttraumatic osteomyelitis following a tibial plafond fracture. The patient underwent implant removal with simultaneous irrigation and debridement of all nonviable bone resulting in a substantial bony void. The nonunion was then stabilized with an antibiotic tibial nail, and an antibiotic cement spacer to fill the bony void. The patient was allowed to partial weight bear post operatively and quickly progressed weight bearing status. By postoperative week eight, the patient’s activity level had returned to near his baseline, and the patient was not interested in another procedure to remove the spacer and bone graft. At this time, it was elected to permanently maintain the cement spacer, and only exchange it for bone graft as needed. By one-year, radiographic films demonstrating bony healing around the cement spacer, and the patient was back to full pain-free function. Conclusions Permanently maintaining the cement spacer in cement augmentation or the Masquelet technique allowed this patient to quickly progress weight-bearing status, regain function, and return to normal life without the need for the stage two procedure.