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Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series

BACKGROUND: Open fractures are a difficult entity, often complicated by infection and nonunion. Bone loss in such fractures adds to the complexity. Conventional techniques of bone defect management are mainly directed toward fracture union but not against preventing infection or joint stiffness. In...

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Autores principales: Kasha, Srinivas, Rathore, Sameer Singh, Kumar, Hemanth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415560/
https://www.ncbi.nlm.nih.gov/pubmed/30967691
http://dx.doi.org/10.4103/ortho.IJOrtho_110_17
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author Kasha, Srinivas
Rathore, Sameer Singh
Kumar, Hemanth
author_facet Kasha, Srinivas
Rathore, Sameer Singh
Kumar, Hemanth
author_sort Kasha, Srinivas
collection PubMed
description BACKGROUND: Open fractures are a difficult entity, often complicated by infection and nonunion. Bone loss in such fractures adds to the complexity. Conventional techniques of bone defect management are mainly directed toward fracture union but not against preventing infection or joint stiffness. In this case series, we evaluated Masquelet's technique for management of open fractures with bone loss. MATERIALS AND METHODS: Twenty seven open fractures with bone defect, which presented within 3 days of trauma were planned for treatment by Masquelet's technique. Followup ranged from 21 to 60 months. RESULTS: Average length of bone defect was 6 cm. Radiological union was obtained at a mean of 280 days since first stage of surgery. Time for union was not related to the size of defect. Union was faster in metaphyseal region (265.6 ± 38.8 days) as compared to diaphysis (300.9 ± 58.6 days). No patient had residual infection after stage 1. All the patients were able to mobilize with full weight bearing after radiological union with a satisfactory range of motion of adjacent joints. CONCLUSION: This technique can be routinely applied in compound fractures with bone loss with good results. Chances of infection are reduced using antibiotic cement spacer as an adjunct to thorough debridement. Induced biomembrane revascularizes the graft. Union can be expected in most of the cases, however, long time to union is a limitation. Technique is cost-effective and does not require special training or instrumentation. Although it is a two-stage surgery, requirement of multiple surgeries, as may be needed in conventional methods, is avoided.
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spelling pubmed-64155602019-04-09 Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series Kasha, Srinivas Rathore, Sameer Singh Kumar, Hemanth Indian J Orthop Original Article BACKGROUND: Open fractures are a difficult entity, often complicated by infection and nonunion. Bone loss in such fractures adds to the complexity. Conventional techniques of bone defect management are mainly directed toward fracture union but not against preventing infection or joint stiffness. In this case series, we evaluated Masquelet's technique for management of open fractures with bone loss. MATERIALS AND METHODS: Twenty seven open fractures with bone defect, which presented within 3 days of trauma were planned for treatment by Masquelet's technique. Followup ranged from 21 to 60 months. RESULTS: Average length of bone defect was 6 cm. Radiological union was obtained at a mean of 280 days since first stage of surgery. Time for union was not related to the size of defect. Union was faster in metaphyseal region (265.6 ± 38.8 days) as compared to diaphysis (300.9 ± 58.6 days). No patient had residual infection after stage 1. All the patients were able to mobilize with full weight bearing after radiological union with a satisfactory range of motion of adjacent joints. CONCLUSION: This technique can be routinely applied in compound fractures with bone loss with good results. Chances of infection are reduced using antibiotic cement spacer as an adjunct to thorough debridement. Induced biomembrane revascularizes the graft. Union can be expected in most of the cases, however, long time to union is a limitation. Technique is cost-effective and does not require special training or instrumentation. Although it is a two-stage surgery, requirement of multiple surgeries, as may be needed in conventional methods, is avoided. Medknow Publications & Media Pvt Ltd 2019 /pmc/articles/PMC6415560/ /pubmed/30967691 http://dx.doi.org/10.4103/ortho.IJOrtho_110_17 Text en Copyright: © 2019 Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Kasha, Srinivas
Rathore, Sameer Singh
Kumar, Hemanth
Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series
title Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series
title_full Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series
title_fullStr Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series
title_full_unstemmed Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series
title_short Antibiotic Cement Spacer and Induced Membrane Bone Grafting in Open Fractures with Bone Loss: A Case Series
title_sort antibiotic cement spacer and induced membrane bone grafting in open fractures with bone loss: a case series
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415560/
https://www.ncbi.nlm.nih.gov/pubmed/30967691
http://dx.doi.org/10.4103/ortho.IJOrtho_110_17
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AT kumarhemanth antibioticcementspacerandinducedmembranebonegraftinginopenfractureswithbonelossacaseseries