Use of fibular graft in Masquelet technique in osteomyelitis of long bones-a novel modification in the technique
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20231996Keywords:
Chronic osteomyelitis, Induced membrane techniqueAbstract
Background: Improper treatment of acute osteomyelitis mostly leads to chronic osteomyelitis. In the year 2000, Alain C. Masquelet described the Induced membrane technique for the first time. In this study, we aimed to determine the clinical efficiency of the Masquelet technique for bone loss due to osteomyelitis in the long bones.
Methods: This study was conducted at our tertiary care centre Shri Vasantrao Naik medical college and hospital, Yavatmal between August 2016 and September 2020. Masquelet technique with some modification was performed in all cases.
Results: In first stage, the defects were filled with antibiotic-loaded polymethyl methacrylate (PMMA) cement after radical debridement. In second stage after 6 to 8 weeks we used a combination of fibular strut graft with iliac cancellous graft. X-rays were taken before second stage and after 3 months, 6 months and 1 year to see for the union. The study included 10 patients, with 6 males and 4 females with mean age of 34 years (20 to 54). The mean duration of bone infection was 4 months (range: 3-5 months). All patients had an average follow-up period of 16 months (range, 12-24 months). Radiographic evidence of bone union was seen in 6 months (3 to 9 months) infection was not seen in any case.
Conclusions: This modified Masquelet is an effective method for the treatment of chronic osteomyelitis of the long bones.
References
Agarwal A, Aggarwal AN. Bone and joint infections in children: acute hematogenous osteomyelitis. Indian J Pediatr. 2016;83(8):817-24.
Masquelet AC, Fitoussi F, Begue T, Muller GP. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chirurg Plast Esthet. 2000;45(3):346-53.
Canavese F, Corradin M, Khan A, Mansour M, Rousset M, Samba A. Successful treatment of chronic osteomyelitis in children with debridement, antibiotic-laden cement spacer and bone graft substitute. Eur J Orthopaed Surg Traumatol. 2017;27:221-8.
Dinh P, Hutchinson BK, Zalavras C, Stevanovic MV. Reconstruction of osteomyelitis defects. Semin Plast Surg. 2009;23:108-18.
Dendrinos GK, Kontos S, Lyritsis E. Use of the Ilizarov technique for treatment of non-union of the tibia associated with infection. J Bone Joint Surg Am. 1995;77(6):835-46.
Gao YS, Ai ZS, Yu XW, Sheng JG, Jin DX, Chen SB, et al. Free vascularised fibular grafting combined with a locking plate for massive bone defects in the lower limbs: a retrospective analysis of fibular hypertrophy in 18 cases. Injury. 2012;43(7):1090-5.
Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R. Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury. 2011;42(6):591-8.
El-Alfy B, Abulsaad M, Abdelnaby WL. A free nonvascularized fibular graft in the induced membrane technique is used to manage post-traumatic bone defects. Eur J Orthop Surg Traumatol. 2018;28:1191-7.
Woon CY, Chong KW, Wong MK. Induced membranes- a staged technique of bone-grafting for segmental bone loss: a report of two cases and a literature review. JBJS. 2010;92(1):196-201.
Scholz AO, Gehrmann S, Glombitza M, Kaufmann RA, Bostelmann R, Flohe S, et al. Reconstruction of septic diaphyseal bone defects with the induced membrane technique. Injury. 2015;46:S121-4.
Micev AJ, Kalainov DM, Soneru AP. Masquelet technique for the treatment of segmental bone loss in the upper extremities. J Hand Surg Am. 2015;40:593-8.
