Interest of nailing associated with the Masquelet technique in reconstruction of bone defect.

Autor: Ayouba G; Department of orthopaedics and traumatology, Comminuty Hospital of Kegue, Lome-Togo, P.O Box 81531, Togo., Lemonne F; Department of Orthopedic and Traumatology, Hôpital de Grasse, 06130, Grasse, France., Kombate NK; Department of orthopedic and traumatology, Hostipal center of Saint-Jean-de- Dieu, Afagnan, P.O Box 1170, Togo., Bakriga B; Department of orthopedic and traumatology, Teaching hospital of Sylvanus Olympio, Lome-Togo, P.O Box 57, Togo., Yaovi Edem J; Department of orthopedic and traumatology, Teaching hospital of Sylvanus Olympio, Lome-Togo, P.O Box 57, Togo., André-Pierre Max U; Department of orthopedic and traumatology, Teaching Hospital of Pointe-à-Pitre, Guadeloupe.
Jazyk: angličtina
Zdroj: Journal of orthopaedics [J Orthop] 2019 Dec 31; Vol. 20, pp. 228-231. Date of Electronic Publication: 2019 Dec 31 (Print Publication: 2020).
DOI: 10.1016/j.jor.2019.12.014
Abstrakt: Introduction: The Masquelet technique based on induced membrane is performed in two stages, first with generally an external fixator which is more and more relayed by an internal fixator. The aim of this study is to assess the results of stabilization by using intramedullary nailing from the first stage.
Patients and Methods: Nine patients were treated for a bone defect concerning 8 femurs and one tibia. The mean size of bone defect was 9.25 cm. It was secondary to a fracture (6 case) with bone defect and two septic and aseptic pseudarthrosis. In all cases the nailing was performed at the first stage of Masquelet. Prior to cement delivery, the site was thoroughly cleaned with iterative excisions as needed. Blood count control, normal CRP and negative culture were required before cement delivery. The cement was placed around the nail and encased the bony extremity. In the second stage, after removal of the cement, the defect was fulfilled by a mixture of cortico-cancellous autogenous graft taken from the iliac crest and phosphocalcic bone substitute. The nail was not changed in any patient. In post operative the mobilization of the above and underlying joints was immediate.
Results: No sepsis was detected before the second time. Early weight bearing was allowed on average at the end of the 2 nd month. Total bearing without support was allowed at a mean of 5.5 months. All patients have consolidated. One patient had a shortening of 2.35 cm. The mean follow-up was 46.1 months. The average period to effective return to work was 21 months.
Conclusion: The nailing performed at the first stage of the induced membrane technique (IMT) gives good results. This modification does not seem to increase the risk of infection. These good results deserve to be confirmed by other studies to confirm the interests of associating nailing to IMT from the first stage.
Competing Interests: Authors declare that they have no competing interest in relation with this manuscript.
(© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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