Arash Moghaddam1, Severin Zietzschmann2, Thomas Bruckner3, Gerhard Schmidmaier2. 1. HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany. Electronic address: arash.moghaddam@med.uni-heidelberg.de. 2. HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany. 3. Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany.
Abstract
BACKGROUND: The successful treatment of atrophic tibia non-unions and tibia non-unions with large bone defects or infections is a major challenge in orthopedic and trauma surgery. This article evaluates the use of the 'diamond concept' using a one-step or two-step procedure according to 'Masquelet technique' in the treatment of atrophic tibia non-unions. METHODS: Between February 2010 and March 2014, 102 patients with atrophic non-unions were treated according to the 'diamond concept' in our center. Ninety-nine were available for follow-up. Forty-nine received a one-step treatment (Group 1, G1) and 50 patients received a two-step treatment according to the 'Masquelet technique' (Group 2, G2). Clinical and radiological parameters were measured preoperatively as well as 4, 6, and 12 weeks and 6 and 12 months postoperatively. In order to evaluate the subjective health of patients, we used the SF-12 questionnaire. Data analysis was performed one year after treatment. RESULTS: The rate of consolidation in G1 was 84% and 80% in G2. The time to heal in G2 was 8.6 ± 2.9 months, which is significantly longer than in G1 being 6.9 ± 3.1 months. In comparison patients in G1/G2 had an average of 3.2/6.7 previous major surgeries. In G1, 4 of 8 patients who did not heal successfully showed positive intraoperative cultures. In G2, 26 patients (52%) initially presented with positive cultures. The results of the SF-12 questionnaire improved in both groups during the postoperative follow-up, but showed no significant differences between groups. In 29 patients a gentamycin-coated nail was used for reosteosynthesis. These patients showed by trend a lower rate of complications at a higher rate of consolidation. CONCLUSIONS: Our study showed that the 'diamond concept' is a suitable method for safely and effectively treating non-unions with large defects or infections. The use of an antibiotic-coated nail provides a therapeutic benefit. For large bone defects of infected non-unions the two-step procedure after Masquelet is an efficient way to eradicate the infection and treat the bone defect successfully.
BACKGROUND: The successful treatment of atrophic tibia non-unions and tibia non-unions with large bone defects or infections is a major challenge in orthopedic and trauma surgery. This article evaluates the use of the 'diamond concept' using a one-step or two-step procedure according to 'Masquelet technique' in the treatment of atrophic tibia non-unions. METHODS: Between February 2010 and March 2014, 102 patients with atrophic non-unions were treated according to the 'diamond concept' in our center. Ninety-nine were available for follow-up. Forty-nine received a one-step treatment (Group 1, G1) and 50 patients received a two-step treatment according to the 'Masquelet technique' (Group 2, G2). Clinical and radiological parameters were measured preoperatively as well as 4, 6, and 12 weeks and 6 and 12 months postoperatively. In order to evaluate the subjective health of patients, we used the SF-12 questionnaire. Data analysis was performed one year after treatment. RESULTS: The rate of consolidation in G1 was 84% and 80% in G2. The time to heal in G2 was 8.6 ± 2.9 months, which is significantly longer than in G1 being 6.9 ± 3.1 months. In comparison patients in G1/G2 had an average of 3.2/6.7 previous major surgeries. In G1, 4 of 8 patients who did not heal successfully showed positive intraoperative cultures. In G2, 26 patients (52%) initially presented with positive cultures. The results of the SF-12 questionnaire improved in both groups during the postoperative follow-up, but showed no significant differences between groups. In 29 patients a gentamycin-coated nail was used for reosteosynthesis. These patients showed by trend a lower rate of complications at a higher rate of consolidation. CONCLUSIONS: Our study showed that the 'diamond concept' is a suitable method for safely and effectively treating non-unions with large defects or infections. The use of an antibiotic-coated nail provides a therapeutic benefit. For large bone defects of infected non-unions the two-step procedure after Masquelet is an efficient way to eradicate the infection and treat the bone defect successfully.
Authors: Fabian Westhauser; Christian Weis; Matthäus Prokscha; Leonie A Bittrich; Wei Li; Kai Xiao; Ulrich Kneser; Hans-Ulrich Kauczor; Gerhard Schmidmaier; Aldo R Boccaccini; Arash Moghaddam Journal: J Mater Sci Mater Med Date: 2016-06-07 Impact factor: 3.896
Authors: Michael C Tanner; Raban Arved Heller; Andreas Grimm; Stefan Zimmermann; Maximilian Pilz; Louisa Jurytko; Matthias Miska; Lars Helbig; Gerhard Schmidmaier; Patrick Haubruck Journal: J Inflamm Res Date: 2021-03-22
Authors: H Bezstarosti; W J Metsemakers; E M M van Lieshout; L W Voskamp; K Kortram; M A McNally; L C Marais; M H J Verhofstad Journal: Arch Orthop Trauma Surg Date: 2020-08-29 Impact factor: 3.067