Masquelet technique for treatment of post-traumatic bone defects

Abstract

Background: Segmental bone defects from traumatic injuries are complicated problems with significant long term morbidity. Historically, amputation was the preferred treatment although, limb salvage by Ilizarov technique, vascularized fibular graft, and acute limb shortening were also used. The treatment regimes were long, burdensome and patient unfriendly involving multiple procedures and complications. Masquelet described the technique of antibiotic cement spacer following debridement for an induced bio-membrane, with subsequent bone- grafting within this space. However, similar results were not reported at multiple centers due to damage to the biomembrane while removal of the cement. Hence, the present study describes the technique of cementation and cement retrieval in order to prevent the damage of the bio-membrane. Objective: To study the outcome of the role of Masquelet technique in the management of post-traumatic (long) bone defects following trauma presenting at our center.Method: 15 patients with mean bone defect of 7.2 cm after debridement were operated with the modified Masquelet technique.Results: Union was obtained in all of the cases; the average time for bony union was 8 months since first presentation with mean follow up of 2.5 years. Conclusion: The technique of delayed bone grafting with definitive fixation after initial debridement and placement of a cement spacer provides excellent results for patients with large posttraumatic bone segment loss.