TREATMENT OF POSTTRAUMATIC INFECTED BONE DEFECTS BY THE INDUCED MEMBRANE TECHNIQUE-CASE REPORT

Abstract

The masquelet technique (induction of biomembrane) is an effective method of bone reconstruction in large segmental defects. The authors have presented a difficult case of a 20 year-old patient, with right femur open comminuted diaphyseal fracture, infected which required repeated interventions: temporary cement spacer followed by staged bone grafting- (autograft and allograft) and finally fixed with an LCP plate. Initially the patient was operated in another orthopaedic hospital for bilateral diaphyseal femur fracture. On the left side a static locking of intramedullary nailing was chosen with favorable evolution. They are in front of an infected major segmental bone defect (12 cm) of the right femur and the first approach was to insert an antibiotic cement spacer (vancomycin) according to masquelet method and to use an single plane external fixator. Six months later, after the biomembrane was induced, they were able to perform the osteoplasty with autograft and allograft. The external fixator was extracted three months later followed by LCP plate osteosynthesis.

OBJECTIVES: THE MASQUELET TECHNIQUE (INDUCTION OF BIOMEMBRANE) IS AN EFFECTIVE METHOD OF BONE RECONSTRUCTION IN LARGE SEGMENTAL DEFECTS.

METHODS: WE PRESENT A DIFFICULT CASE OF A 20 YEAR-OLD PATIENT, WITH RIGHT FEMUR OPEN COMMINUTED DIAPHYSEAL FRACTURE, INFECTED WHICH REQUIRED REPEATED INTERVENTIONS: TEMPORARY CEMENT SPACER FOLLOWED BY STAGED BONE GRAFTING- (AUTOGRAFT AND ALLOGRAFT) AND FINALLY FIXED WITH AN LCP PLATE.

INITIALLY THE PATIENT WAS OPERATED IN ANOTHER ORTHOPAEDIC HOSPITAL FOR BILATERAL DIAPHYSEAL FEMUR FRACTURE.

ON THE LEFT SIDE A STATIC LOCKING OF INTRAMEDULLARY NAILING WAS CHOSEN WITH FAVORABLE EVOLUTION.

ON THE OTHER SIDE, AT FIRST A THOROUGH WOUND DEBRIDEMENT WAS MADE, THEN AN EXTERNAL FIXATOR WAS INSTALLED FOLLOWED BY LOCKED INTRAMEDULLARY NAILING.

IN EVOLUTION THE WOUND BECAME INFECTED WITH STAPHYLOCOCCUS, ENTEROBACTER,AND KLEBSIELLA. THE INFECTION WAS TREATED BY NAIL EXTRACTION, SUSTAINED ANTIBIOTIC THERAPY AND EXTERNAL FIXATION.

AT THAT MOMENT THE PATIENT WAS REFERRED TO OUR CENTRE.

RESULTS WE ARE IN FRONT OF AN INFECTED MAJOR SEGMENTAL BONE DEFECT (12 CM) OF THE RIGHT FEMUR AND THE FIRST APPROACH WAS TO INSERT AN ANTIBIOTIC CEMENT SPACER (VANCOMYCIN) ACCORDING TO MASQUELET METHOD AND TO USE AN SINGLE PLANE EXTERNAL FIXATOR. SIX MONTHS LATER, AFTER THE BIOMEMBRANE WAS INDUCED, WE WERE ABLE TO PERFORM THE OSTEOPLASTY WITH AUTOGRAFT AND ALLOGRAFT. THE EXTERNAL FIXATOR WAS EXTRACTED THREE MONTHS LATER FOLLOWED BY LCP PLATE OSTEOSYNTHESIS

A GOOD FUNCTIONAL OUTCOME (EVALUATED BY SF 36) WAS OBTAINED SEVEN MONTHS AFTER THE LAST INTERVENTION.

CONCLUSION: THE USE OF THE MASQUELET TECHNIQUE ENSURED AN ANATOMICAL RECONSTRUCTION AND A SATISFYING FINAL FUNCTIONAL OUTCOME.

KEYWORDS: SEGMENTAL BONE DEFECT, MASQUELET, INDUCTION OF BIOMEMBRANE.