Masquelet technique for the treatment of open pilon fractures with segmental bone defects

Abstract

Objective To evaluate the Masquelet technique used in the treatment of open pilon fractures complicated with segmental bone defects.Methods From August 2005 to June 2010,we used the Masquelet technique to treat 16 open pilon fractures with metaphyseal bone loss.They were 11 men and 5 women,aged from 20 to 67 years (average,36.5 years).Ten fractures were right and 6 left.By AO/ASIF classification,there were 7 cases of type C2 and 9 type C3.Five had long segmental defects and 11 lacunar defects.By Gustilo classification,10 open injuries were type ⅢA and 6 type Ⅲ B.All patients were treated with immediate debridement,antibiotic cement spacer placement at the site of the bone defect and external fixation.After a delay of 6 to 8 weeks when the patients had a healed soft tissue envelope and no sign of infection,they were treated with removal of external fixation,open reduction,bone grafting and plate fixation.Results All the patients were followed up from 6 to 48 months (average,24 months).Bone union was achieved in all patients,with an average duration of 21 weeks (from 13 to 58 weeks).No acute deep infection or wound necrosis occurred after plate fixation.According to the Burwell-Charnley scoring,anatomic reduction was achieved in 6 cases,functional reduction in 9,and unsatisfactory reduction in one.According to the American Orthopaedic Foot and Ankle Society (AOFAS) scale for the ankle joint,the scores of ankle function ranged from 62 to 98 points,with an average of 85.6 points.Conclusion The Masquelet technique is simple but effective for the treatment of open pilon fractures complicated with bone defects. Key words: Tibial; Fracture; Fractures, open; Bone defects; Masquelet technique