Masquelet technique combined with antibiotic coated intramedullary nail fixation for the treatment of lower limb infect-ed bone defects

Abstract

Objective To explore the clinical effect of Masquelet membrane induction technique combined with antibiot-ic coated intramedullary nail fixation in the treatment of lower limb large segment infected bone defects. Methods From June 2009 to August 2015, 53 patients who have lower limb large segment infected bone defects were analyzed retrospectively, includ-ing 40 males and 13 females, aged from 23 to 61 years, with an average age of 36.2±8.4 years. 37 cases were secondary to infection after fracture surgery, and 16 cases were caused by open fractures. There were 17 cases of femoral shaft defects and 36 cases of tib-ia diaphysis defects. All 53 cases were treated with Masquelet technique. The first stage was infection debridement, then bone de-fect was filled by bone cement mixed with sensitive or broad-spectrum antibiotics, and then temporary fixation was given. When the infection was controlled, debridement was given again and sensitive antibiotic bone cement was replaced to induce membrane, and antibiotic coated intramedullary nail was used for internal fixation. In the second stage, after intramedullary nailing internal fixation for 4-6 weeks, the bone cement occupying device was taken out and the autologous cancellous bone was planted in the in-duced membrane. Then the membrane was covered and sutured. The cure rate of infection, the time of bone healing and the relat-ed complications were observed. Results 53 patients were followed up for 24 to 63 months (with an average of 39±4.7 months). The length of tibia bone defect after debridement was 6-15 cm (average 8.7±4.9 cm). 49 patients’ infection were cured in 12 months after operation, and the bone defects were healed, with healing time of 5.3-9.7 months (mean 7.4±3.2 months). No refrac-ture occurred. The healing time of tibia was 7.8±2.1 months, while the healing time of the femur was 7.2±3.9 months. 1 case of fem-oral shaft defect had recurrence of infection 4 months after membrane induced bone grafting, and the first stage treatment was re-started which were debridement and implantation of sensitive antibiotic bone cement occupying device. After 6 weeks, the infec-tion was controlled and the second stages continued. 3 cases’s (2 cases of femoral shaft, 1 case of tibial shaft) autologous cancel-lous bone were absorbed 3 to 6 months after operation, and no bone density increased in the bone defect area. The autologous can-cellous bone was reimplanted and the bone defect was cured in 8 months. Conclusion Masquelet technology combined with anti-biotic coated intramedullary nailing can effectively control infection and create a good biological and mechanical environment for bone defect repair. It has good clinical efficacy. Key words: Infection; Wounds and injuries; Fracture fixation, intramedullary