Treatment Of Posttraumatic Osteomyeltis Of Lower Limbs With Masquelet Technique And Single Stage Bone Grafting

Background:Posttraumatic osteomyelitis, which is a type of biofilm infection, mostly can be seen inlower limbs. Treatment of this kind of disease can be prolonged procedure and the infectionis easily repeated. Many people lost their limbs because of economic and technologicalreasons, or skin cancer. This brings to much burden both to the family and the society.Clinical study out and home reported the outcome and the curing methods were differentfrom place to place. Because treatment of osteomyelitis is a kind of comprehensive and hightheoretical level demanded stubborn illness. Surgeons use varies ways and tools to controlinfection and reconstruct bone defects in different countries, which bring many difficultiesto unification. Some parts of clinical surgeon still use some traditional methods, which arenot helpful and delay of the illness. Standardization and Evidence-based is the trend of thetreatment of osteomyelitis in the future.Antibiotic irrigation is on the verge of obliteration, because leakage and unmanageable.Antibiotic beads are a kind of drug carrier, which releases high dosage of antibiotics toeliminate those bacterioplankton after debridement. In the meantime, the filled beadsobliterate the dead spaces. Handmade PMMA can release the same antibiotics too, but theconcentration and time are lower and shorter. Pathogenic bacteria under the shield ofbiofilm are1000more drug resistance compare with those normal bacteria. Neitherantibiotic beads nor handmade PMMA can obliterate those biofilm bacteria. If we amplifythe radical debridement, such as amputation, we can handle the wounds as might bepolluted. If we can do the debridement thoroughly, the short time local and systematicalusing antibiotics can be successful. Bone defects reconstruction was traditionally carried out2-3months later after the debridement. The classical curing method is Ilizarov Technique.This method presents many advantages as well as disadvantages in settling various clinicaldifficulties. Most of the patients were ill for a long time with heavy psychological burden. Itmeans a lot to alleviate their pain and shorten the treatment period. Masquelet technique is more acceptable and time saving bone reconstruction way. Many clinical studies reportedthis method and obtained good outcome. We would like to present the clinical outcome ofMasquelet technique in settling osteomyelitis bone defects and compare this kind oftechnique with traditional singe stage bone grafting method.Objectives：The purpose of this study was to discussion the Masquelet technique in curingosteomyelitis bone defects of lower limbs and observing the bone healing process after thetreatment. Based on this clinical study, we would like to compare the Masquelet techniquewith single stage autologous bone grafting in dealing with posttraumatic osteomyelitis andevaluate the clinical outcome of these two methods.Methods:From June2012to October2013,27patients suffering from posttraumaticosteomyelitis of lower limbs were collected and treated with Masquelet technique, including20male and7female. X-rays radiograph were gathered to analyze the bone healing processand clinical follow-up were carried out at certain time interval to evaluate the efficacy ofinfection control. These patients were compared with25single stage autologous bonegrafting patients, which were collected between January2010and August2012. Accordingto Cierny-Mader classification,27patients were classified as6case of ⅢA type,4case ofⅢB type,10case of ⅣA type,7case of ⅣB type in the Masquelet group and25patientswere classified as3case of ⅢA type,6case of ⅢB type,8case of ⅣA type,6case ofⅣB type in the single stage group.Results:All27patients were given intravenous antibiotics for2weeks in the Masquelet group.Only3patients went though second debridement because exudation of the insection, theinfection control rate after the first debridement was88.9%(24/27) and none of the cases gotinfection recurrence after bone grafting.18patients with segmental bone defects, theaverage length of the defects were4.54cm (1.95-9.03).23of the cases got radiological bonehealing at6months.3cases present delayed healing in the first6months after the surgeryand1case presents absorption. The bone union rate was96.3%(24/27).Most of the patients in single stage group were given2-3weeks of intravenousantibiotics.5patients got infection recurrence after bone grafting and went though second debridement, the infection control rate after the first debridement was80.0%(20/25).15patients with segmental bone defects, the average length of the defects were2.50cm(0.50-3.80).7cases present bone absorption. The bone union rate was72.0%(18/25).Conclusion：1. Biofilm nidus is the fundamental reason of recrudescent osteomyelitis. Based on thethoroughly radical debridement and local antibiotic carrier，short duration of intravenousantibiotic can fulfill the duty of control infection.2. Bone reconstruction is the core technology in the treatment of infected bone defects.Masquelet technique is substantially undervalued method. The formation of callus is quickand the bone union time is not confine by the reconstruction length in this technique. Thelocally used PMMA is for multiple purposes, such as antibiotic carrier, dealing with deadspace, inducing a membrane for bone reconstruction.3. Compare with single stage bone grafting, the bone defects are longer and theinfection control rate are higher with masquelet technique in the construction of an infectedbone defects.4. Compare with staged bone reconstruction method, bone absorption was more likelyoccurred in the single stage group, but some small segmental defects and infection resultedfrom simple bone fracture can be treated with this technique.