Treatment of Post - traumatic Bone Defects with infection in L ong B ones

Background: Open fractures are a challenging condition to treat because they are frequently compounded by infection and nonunion. Traditional bone defect care strategies are mostly focused on fracture union rather than infection prevention. The goal of this study is t o use the Masquelet approach to examine the outcome of a post - traumatic defect with infection in long bones. This method is a two - step process. Stage I surgery includes debridement and the placement of an antibacterial spacer in the bone defect. Stage II s urgery involved removing the spacer while preserving the induced membrane that had grown on the spacer's surface and filling the bone - gap with morselized iliac crest bone - graft within the membrane sleeve. Methods: There were 22 patients in this study (18 m ales and 4 females), all of them had infected long bone fractures with a bone defect. The average length of the bone defect was 3.5 centimetres. The duration of follow - up varied from 6 to 15 months. Results: After an average of 11.5 weeks following the fir st step of surgery, radiological union was achieved. After stage 1, no patient had any remaining infection. After radiological union, all of the patients were able to mobilise with full weight bearing and a satisfactory range of motion in the adjoining joi nts. Conclusion: With favourable outcomes, this treatment can be used on infected fractures with bone loss on a regular basis. Antibiotic cement spacers, used in conjunction with complete debridement, minimise the risk of infection. The graft is revascular ized through induced biomembrane. In most circumstances, union may be predicted; nonetheless, the length of time it takes to reach an agreement is a constraint. The technique is low - cost and does not necessitate any additional training or equipment. Despit e the fact that it is a two - stage procedure, it does not necessitate several surgeries as in traditional approaches.

Limb Reconstruction Using Masquelet Technique in the Treatment of Post-traumatic Compound Tibial Fractures with Bone Loss

Introduction: Traumatic segmental bone defects of leg are difficult problem to manage with significant long-term morbidity.Historically, due to difficulty in managing segmental bone defects, amputation was the preferred treatment. Later over the lasthalf-century, limb salvage was done using various techniques such as vascularized fibular grafts, acute limb shortening, externalfixator application, and filling the defect with autograft or allograft. More recently, Masquelet described the use of cement spacerapplication within this defect and staged bone grafting within the induced biomembrane formed around the spacer as a potentialtreatment strategy to manage these bone defects.Method: This study describes the clinical, radiological, and functional outcome in 20 patients with traumatic bone loss of up to5 cm managed using Masquelet technique.Results: The outcome was analyzed using Association for the study and application of methods of ilizarov (ASAMI) scorewhich showed excellent results in 10 patients, good in 5 patients, fair in 2 patients, and poor in 3 patients.Conclusion: We conclude that the induced membrane technique can be a valuable addition to the armamentarium of limbreconstruction procedures in patients with small bone defects with or without soft tissue injury.

Vancomycin-Loaded Bone Cement Bullet for Treatment of Chronic Septic Arthritis Post ACL Reconstruction Surgery

Abstract@#The consequence of post-operative infection can be devastating despite its rare incidence. Common organisms causing post-operative infection are normal flora of the skin: Staphylococcus aureus and Staphylococcus epidermidis. Early diagnosis followed by arthroscopic debridement and antibiotic therapy with graft retention remains the main aim of treatment. However, there are certain cases where the infection persists despite early intervention. Vancomycin-loaded bone cement bullet inserted into bone tunnel can provide a high local concentration of vancomycin with bactericidal effect and low systemic complications to treat deep-seated infection.

Antibiotic cement-coated Unreamed nailing for Treatment of Infected Nonunion of Long bone / 대한정형외과학회잡지

PURPOSE: Our study was aim to evaluate the results of treatment by antibiotic cement-coated unreamed nailing for infected nonunion of long bone shaft. MATERIALS AND METHODS: Ten cases of nonunion, 6 femurs and 4 tibias were included in this study. Average age of patients was 38.5 and men were eight. Average follow-up period was 16.4 months (12-35) . Etiologies of infection were open fractures (6 cases) and iatrogenic (4 cases) . Eight cases which had positive antimicrobial sensitivity test preoperatively were used a sensitive, heatstable, and powderform antibiotics. Primary autogenous bone grafting with nailing was perfomed in five cases. Delayed bone grafting after curettage and nailing was done in another five cases in infected by S. aures organism. RESULTS: All of ten cases had bony union. Union time was average 31.5 in femur and 26.4 in tibia. Early weight bearing ambulation and motion of adjacent joint were beneficial. But average 8 mm of shortening was developed and angulation more than 5 degrees occured in one case. CONCLUSION: Antibiotic cement coated-unreamed intramedullay nailing is the recommended treatment of method in infected nonunion of long bone shaft with minimal shortening.