Infected Post-traumatic Bone Defect of the Knee using Bipolar Osteochondral Allograft and 3D Printing: A Case Report.

Introduction: Transplantation with fresh cadaveric osteochondral allograft (FOCA) is frequently used in defects of the femoral condyle and tibial plateau to preserve the knee joint. However, the use of FOCA in bipolar lesions remains controversial in cases with bipolar defects and a history of infection. Case Report: We present a 21-year-old male patient with a massive post-traumatic osteochondral defect of the lateral compartment of the knee and a history of infection, treated by a two-stage approach. In stage 1, infection was eradicated, and joint function recovered with aggressive debridement, polymethyl methacrylate beads, bone cement spacers, and Judet's quadricepsplasty. In stage 2, transplantation was performed with a bipolar FOCA. All treatments were planned using 3D-printed models. Conclusion: The two-stage approach and 3D planning can increase the chances of transplant success by preparing the future allograft bed and obtaining an optimal match between the cadaveric allograft and the patient's defect in cases with potential contraindications, such as a bipolar lesion in the femoral condyle and tibial plateau and a history of infection. A combined approach may lead to a more beneficial outcome for the patient to preserve joint function and improve quality of life.

PRECICE nail for the management of posttraumatic bone defects with nonunion or malunion: Experience from a Latin American center.

BACKGROUND: To evaluate the clinical outcomes using the PRECICE magnetic limb lengthening intramedullary nail for the correction of lower limb length discrepancies (LLD) in adults with posttraumatic nonunion or malunion defects in a Latin American center. METHODS: A retrospective review of 25 adult patients with LLD associated with posttraumatic nonunion or malunion defects of femur or tibia treated with the PRECICE nail between January 2018 and December 2020. The primary outcomes considered were lengthening length achieved in mm, incidence of complications and quality of life (EQ-5D-3 L questionnaire). RESULTS: Twenty-five cases (20 femoral and 5 tibial nails) were performed, with a median follow-up of 27 months (Interquartile range-IQR: 17.5 to 34.5). The average age was 36.5 ± 12.9 years; 10 cases were women. Fifteen cases had an LLD secondary to a malunion defect and 10 cases had an LLD secondary to a nonunion. PRECICE nails were inserted for the treatment of a median LLD of 40.0 mm (IQR: 30.2 to 74.2) in the femur and 30.0 mm (28.5 to 50.0) in the tibia. An accuracy of 100% was reported in 18 cases (Femur: 14 and tibia: 4) and consolidation was achieved in 22/25 cases with the PRECICE nail in situ. Complications were recorded in 9 (36%) cases (6/20 femur, 3/5 tibia), mainly related to the consolidation process (5/9). The median EQ-5D and EQ-VAS were 0.79 (IQR: 0.63 to 0.79) and 80.0 (IQR: 50.0 to 90.0), respectively. CONCLUSIONS: The results of this study demonstrated that the PRECICE nail is an effective device for the management of posttraumatic LLD during the treatment of nonunion or malunion bone defects of femur and tibia, offering a reasonable quality of life, despite its postoperative complication risk.

Orthoplastic management of distal tibia bone infection using Masquelet technique and PRECICE nail: A case report.

The orthoplastic treatment of post-traumatic bone infections is complex and requires a multidisciplinary approach using both orthopedic and plastic surgery principles. Its primary goal is to achieve rapid control of the infection through aggressive debridement of the affected tissue, in order to perform a complete reconstruction of the limb. This allows both its salvage and restoration of function. We present a patient with septic non-union secondary to distal tibia fracture with a bone defect of 7 cm and severe soft tissue injury. The treatment was divided into three stages. First, the infection was controlled by radical debridement, limb shortening, and temporary stabilization. Second, early reconstruction was initiated utilizing the first stage of the Masquelet's induced membrane technique (MIMT), and soft tissue coverage with free flap. Third, MIMT was finalized, and bone lengthening with PRECICE nail was performed. We consider this approach effective as it can offer early recovery with optimal functional and aesthetic results in bone defects associated with coverage defects.