Masquelet technique to treat a septic nonunion after nailing of a femoral open fracture.

Septic nonunion is one of the most serious complications after an open fracture because both the infection and the bone defect need to be dealt with. Treatment is always protracted and expensive, and the result is uncertain. In the 1980s, Masquelet first described the technique of the induced membrane and autologous bone grafting to manage critical size bone defects. In septic nonunions, the described approach, characterised by two different surgical steps, allows a radical approach to manage the infection, and gives a significant biological stimulus to bone healing. In this case, we present a 35-year-old male patient with an open grade II femoral shaft fracture (AO / OTA 32C3). The patient was initially treated with an intramedullary nail and the resulting septic nonunion was subsequently managed with the induced membrane technique and a double-plate osteosynthesis to protect the biological chamber.

Wrist and hand ultrasound.

With adequate equipment, training, and expertise, ultrasound (US) should be regarded as the first-line imaging modality for the assessment of a wide range of pathological conditions affecting the soft tissues around the wrist and hand. With high-resolution transducers, US allows detection of foreign bodies and a reliable identification of a variety of traumatic lesions affecting tendons, retinacula and annular pulleys, ligaments, vessels, and nerves. In addition, inflammatory arthropathies, infectious disorders, overuse tendinopathies, and degenerative conditions can be diagnosed with this technique. In the wrist, US is able to identify the entrapment of the median, ulnar, and radial nerves. In patients with localized soft tissue swelling, US is able to assess the presence of a space-occupying lesion and to characterize its nature in many cases.