Management of Infected Segmental Bone Defects with Antibiotic-Cement-Coated Nails in the First Stage of the Masquelet Technique. Implantation and Removal of the Cement Spacer around the Nail: A Technical Note

Document Type : TECHNICAL NOTE

Authors

1 Orthopaedic and Trauma Surgery Department, British Hospital of Buenos Aires, Argentina

2 Orthopaedic and Trauma Surgery; and Ortho-Plastic Department, British Hospital of Buenos Aires, Argentina

Abstract

Infected segmental bone defects (ISBD) of the femur and tibia pose a significant challenge. 
Traditionally, bone fixation in the first stage of the Masquelet technique involves external fixation, but 
intramedullary nail fixation has recently gained popularity. Despite this, little attention has been focused 
on the elaboration, implantation, and removal of the spacer around the nail. In this technical note, we 
present gentamicin cement-coated rigid nails as definitive fixation in the first stage. We also detail the 
technique for placing and removing the one-piece dyed antibiotic spacer around the nail. We highlight 
its potential benefits in one of the critical steps of this versatile technique.
 Level of evidence: IV

Keywords

Main Subjects

References

  1. Masquelet AC, Fitoussi F, Begue T, Muller GP. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann de Chir Plast Esthet 2000; 45(3):346-353.

2-    Masquelet A, Kanakaris NK, Obert L, Stafford P, Giannoudis P V. Bone repair using the Masquelet technique. J Bone Joint Surg Am. 2019; 101(11):1024–1036. doi: 10.2106/JBJS.18.00842.

3-    Sharma A, Sharma A, Tomar S, Mishra A, Kashyap A, Maini L.

 

Is Masquelet technique a successful viable treatment in reconstructing large tumor bone gaps in adolescent and adult? Arch Bone Jt Surg. 2023; 11(5):348-355.

4-    Pesciallo CA, Garabano G, Dainotto T, Ernst G. Masquelet technique in post-traumatic infected femoral and tibial segmental bone defects. Union and reoperation rates with high proportions (up to 64%) of allograft in the second stage. Injury.2021; 52(11):3471-3477. doi: 10.1016/j.injury.2021.08.031.

5-    Garabano G, Pesciallo CA. Definitive fixation in the first stage of the induced membrane technique for septic segmental bone defects. Why not? J Clin Orthop Trauma.2022:37:102089. doi: 10.1016/j.jcot.2022.102089.

6-    Ahmadi N. Effects of combination of BMP7, PGF, and autograft on healing of the experimental critical radial bone defect by induced membrane (Masquelet) technique in rabbit. Arch Bone Jt Surg.2021; 9(5):585-597. doi: 10.22038/abjs.2020.50852.2532.

7-    Hoit G, Kain MS, Sparkman JW, et al. The induced membrane technique for bone defects: Basic science, clinical evidence, and technical tips. OTA Int. 2021; 4(2 Suppl):e106 (1-5). doi: 10.1097/OI9.0000000000000106.

8-    Garabano G, Pereira S, Alamino LP, et al. Antibiotic cement-coated rigid locked nail in infected femoral and tibial nonunion. Reoperation rates of commercial versus custom-made nails. Injury.2023:54 Suppl 6:110650. doi: 10.1016/j.injury.2023.02.033.

9-    Walter N, Rupp M, Kruckel J, Alt V. Individual and commercially available antimicrobial coatings for intramedullary nails for the treatment of infected long bone non-unions – a systematic review. Injury.2022:53 Suppl 3:S74-S80. doi: 10.1016/j.injury.2022.05.008.

10- Lopas LA, Albertson S, Solomon E, et al. Outcomes of various antibiotic cement-coated intramedullary implants on the treatment of long bone septic nonunion. J Orthop Trauma.2022; 36(2):44-50. doi: 10.1097/BOT.0000000000002215.

11- Metsemakers WJ, Morgenstern M, Senneville E, et al. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg.2020; 140(8):1013-1027. doi: 10.1007/s00402-019-03287-4.

12- Ayouba G, Lemonne F, Kombate NK, Bakriga B, Yaovi Edem J, Andre-Pierre Max U. Interest of nailing associated with the Masquelet technique in reconstruction of bone defect. J Orthop.2019:20:228-231. doi: 10.1016/j.jor.2019.12.014.

 

 

 

 

The Archives of Bone and Joint Surgery
Volume 12, Issue 9
September 2024
Pages 665-668

Files

History

  • Receive Date: 08 June 2023
  • Revise Date: 18 July 2024
  • Accept Date: 20 July 2024

Share

How to cite

Statistics