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


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 cementcoated rigid locked nail in infected femoral and tibial 
nonunion. Reoperation rates of commercial versus custommade 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