Masquelet technique used for open limb fractures caused by gunshots / 中华创伤骨科杂志

Objective:To report our experience of treating open comminuted limb fractures caused by gunshots using the Masquelet technique.Methods:Between January 2016 and July 2018, 3 patients were admitted to Institute of Orthopedics, 920 Hospital of Joint Logistic Service of People's Liberation Army for open comminuted limb fractures caused by gunshots.They were all male, aged from 18 to 41 years (average, 30.7 years).Their fractures were complicated with perforating wounds and belonged to Gustilo type ⅢB for open fractures.The bone defects were 5 to 9 cm in length (average, 6.7 cm), located at the proximal femur in 2 cases and at the upper middle humerus in one.They were treated by standard Masquelet technique at 2 stages.The postoperative functions of the hip, knee and shoulder were evaluated according to the Harris hip score, Lowa knee score and Constant-Murley shoulder function score.Results:The 3 patients obtained an average follow-up of 17.3 months.The bone defects were all repaired in the 3 patients without any signs of infection.The 2 patients with femoral defects were rated as both excellent by the Harris hip score, as excellent in one and as good in the other by the Lowa knee score; the patient with humeral defects was rated as excellent by the Constant-Murley shoulder function score.Conclusion:Masquelet technique is a desirable treat-ment of segmental long bone defects caused by gunshots.

Induced membrane technique and microsurgery for open leg fractures of Gustilo types ⅢB-C / 中华创伤骨科杂志

Objective To evaluate the induced membrane technique combined with microsurgery for repair of open leg fractures of Gustilo types Ⅲ B-C.Methods This retrospective study reviewed 15 patients who had been treated for open leg fractures of Gustilo types ⅢB and ⅢC by the induced membrane technique and microsurgery between January 2015 and January 2017 at Institute of Orthopedics,920 Hospital,The Joint Logistic Service of The People's Liberation Army.They were 10 men and 5 women,aged from 18 to 41 years (average 32 years).There were 9 cases of Gustilo type ⅢB and 6 ones of Gustilo type ⅢC.After thorough debridement,the fractures were reduced and fixated temporarily using external frames.The bone defects were filled with antibiotic bone cement to induce biofilm formation.After necessary reconstruction of limb structures,including neurovascular repair and transposition of tendon and nerve,crucial soft-tissue wounds were covered with surgical flaps.In the secondary surgery 6 to 8 weeks later,with the external frames replaced by internal fixation or not,the bone cement was removed without damaging the biofilm before graft reconstruction with autogenous cancellous bone.Results The 15 legs were all salvaged successfully.The in-hospital time ranged from 21 to 39 days (mean,29 days).Crucial wounds were repaired primarily without any severe or persistent infection.Follow-ups ranged from 12 to 24 months (average,15 months).Bone union time ranged from 10 to 17 months (average,11.2 months) with satisfactory aesthetic and functional recovery of the leg.Conclusion Reconstruction of open leg fractures of Gustilo types Ⅲ B-C with induced membrane technique and microsurgery can result in decreased therapeutic duration,reduced complications and positive outcomes.

Induced membrane technique and microsurgery for open leg fractures of Gustilo types ⅢB-C / 中华创伤骨科杂志

Objective@#To evaluate the induced membrane technique combined with microsurgery for repair of open leg fractures of Gustilo types ⅢB-C.@*Methods@#This retrospective study reviewed 15 patients who had been treated for open leg fractures of Gustilo types ⅢB and ⅢC by the induced membrane technique and microsurgery between January 2015 and January 2017 at Institute of Orthopedics, 920 Hospital, The Joint Logistic Service of The People’s Liberation Army. They were 10 men and 5 women, aged from 18 to 41 years(average 32 years). There were 9 cases of Gustilo type IIIB and 6 ones of Gustilo type IIIC. After thorough debridement, the fractures were reduced and fixated temporarily using external frames. The bone defects were filled with antibiotic bone cement to induce biofilm formation. After necessary reconstruction of limb structures, including neurovascular repair and transposition of tendon and nerve, crucial soft-tissue wounds were covered with surgical flaps. In the secondary surgery 6 to 8 weeks later, with the external frames replaced by internal fixation or not, the bone cement was removed without damaging the biofilm before graft reconstruction with autogenous cancellous bone.@*Results@#The 15 legs were all salvaged successfully. The in-hospital time ranged from 21 to 39 days (mean, 29 days). Crucial wounds were repaired primarily without any severe or persistent infection. Follow-ups ranged from 12 to 24 months (average, 15 months). Bone union time ranged from 10 to 17 months (average, 11.2 months) with satisfactory aesthetic and functional recovery of the leg.@*Conclusion@#Reconstruction of open leg fractures of Gustilo types Ⅲ B-C with induced membrane technique and microsurgery can result in decreased therapeutic duration, reduced complications and positive outcomes.