Laurent Mathieu1,2, Léon Tossou-Odjo3, Nicolas de l'Escalopier3, Thomas Demoures4, Arnaud Baus5, Michel Brachet5, Alain Charles Masquelet6. 1. Clinic of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France. laurent_tom2@yahoo.fr. 2. Department of surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphonse Laveran, 75005, Paris, France. laurent_tom2@yahoo.fr. 3. Clinic of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France. 4. Clinic of Orthopedics and Traumatology, Bégin Military Hospital, 69 avenue de Paris, 94160, Saint-Mandé, France. 5. Clinic of Esthetic and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140, Clamart, France. 6. Clinic of Orthopedics, Trauma and Hand Surgery, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
Abstract
PURPOSE: To evaluate a novel sequential internal fixation strategy using a reinforced spacer for infected bone defect reconstruction by the induced membrane technique (IMT). METHODS: A retrospective case study was performed among patients treated for infected bone defects by applying this strategy. Following radical debridement, temporary stabilization was provided by a massive cement spacer combined with minimal intramedullary fixation during step 1. Definitive internal fixation was performed together with bone grafting at step 2. RESULTS: Eight patients with a mean age of 58 years were reviewed. The mean bone defect length was 8.8 cm. The spacer armature mostly consisted of elastic nails and Steinmann pins. Iterative debridement was required in one case after step 1. The mean interval between steps was 12 weeks. Definitive internal fixation was performed by intramedullary nailing (n = 4) or plating (n = 4). At a mean follow-up of 21 months, bone union was achieved in seven cases without additional bone grafting or infection recurrence. CONCLUSIONS: Sequential internal fixation using a reinforced cement spacer seems to be a valuable option for avoiding external fixation between IMT steps and limiting the recurrence of infection.
PURPOSE: To evaluate a novel sequential internal fixation strategy using a reinforced spacer for infected bone defect reconstruction by the induced membrane technique (IMT). METHODS: A retrospective case study was performed among patients treated for infected bone defects by applying this strategy. Following radical debridement, temporary stabilization was provided by a massive cement spacer combined with minimal intramedullary fixation during step 1. Definitive internal fixation was performed together with bone grafting at step 2. RESULTS: Eight patients with a mean age of 58 years were reviewed. The mean bone defect length was 8.8 cm. The spacer armature mostly consisted of elastic nails and Steinmann pins. Iterative debridement was required in one case after step 1. The mean interval between steps was 12 weeks. Definitive internal fixation was performed by intramedullary nailing (n = 4) or plating (n = 4). At a mean follow-up of 21 months, bone union was achieved in seven cases without additional bone grafting or infection recurrence. CONCLUSIONS: Sequential internal fixation using a reinforced cement spacer seems to be a valuable option for avoiding external fixation between IMT steps and limiting the recurrence of infection.
Entities:
Keywords:
Bone defect; Induced membrane technique; Masquelet technique; Post-traumatic osteomyelitis
Authors: Laurent Mathieu; James Charles Murison; Arnaud de Rousiers; Nicolas de l'Escalopier; Didier Lutomski; Jean-Marc Collombet; Marjorie Durand Journal: Clin Orthop Relat Res Date: 2021-12-01 Impact factor: 4.176
Authors: Laurent Mathieu; Romain Mourtialon; Marjorie Durand; Arnaud de Rousiers; Nicolas de l'Escalopier; Jean-Marc Collombet Journal: Mil Med Res Date: 2022-09-02