Aeromonas hydrophilia-infected nonunion of a closed tibial fracture in a healthy adolescent: A case report

Aeromonas hydrophilia can cause soft tissue infection in both immunocompromised and healthy persons. A healthy 15-year-old adolescent fell into a ditch after a scooter accident and sustained a right distal tibial shaft closed fracture, a right femoral shaft closed fracture, and a dirty laceration over the medial aspect of the distal thigh above the right knee. After empiric antibiotics and radical debridement of the contaminated wound, a femoral interlocking nail and tibial external fixator were applied. However, acute osteomyelitis later presented in his femur and tibia, and Aeromonas hydrophilia grew in cultures from the knee wound and the fracture sites. During the follow-up, his tibia became an infected nonunion, and was successfully treated with the induced membrane technique. In an otherwise healthy patient with a closed fracture, Aeromonas hydrophilia can cause acute osteomyelitis and necrotizing fasciitis by spreading from a nearby contaminated wound. Exposure to water is a risk factor for Aeromonas hydrophilia infection.

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The Induced Membrane Technique for the Management of Segmental Tibial Defect or Nonunion: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2020/5893642 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Chen-An Hsu ◽

Shih-Heng Chen ◽

Soa-Yu Chan ◽

Yi-Hsun Yu

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Postoperative Infection ◽

Meta Analysis ◽

Union Rate ◽

Infected Nonunion ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique ◽

The Mean

Purpose. To identify the predicting factors for union and infection after applying the induced membrane technique (IMT) for segmental tibial defects. Methods. A systematic review was carried out following the PRISMA guidelines. All databases were searched for articles published between January 2000 and February 2018 using the keywords “Masquelet technique” and “induced membrane technique.” Studies in English reporting more than 5 cases with accessible individual patient data were included. A meta-analysis was performed. Odds ratios (OR) with 95% confidence intervals were calculated. Results. After reviewing, 11/243 studies (115 patients) were finally selected. The mean age of the patients was 43.6 years (range: 18-84 years), and the mean length of the tibial defect was 5.5 cm (range: 0-20 cm). The multivariate logistic regression analysis revealed that the risk factors of postoperative infection after IMT were infected nonunion (p=0.0160) and defect length ≥7 cm (p=0.0291). Patients with postoperative infection after IMT had a lower union rate (p=0.0003). Additionally, the use of an antibiotic polymethyl methacrylate cement spacer reduced the need for surgical revision (p=0.0127). Multiple logistic regression indicated no direct association between the union rate and length of the bone defect. Conclusions. IMT is a reliable and reproducible treatment for segmental tibial defects. However, initial infected nonunion and defect length greater than 7 cm are risk factors for post-IMT infection, and post-IMT infection was statistically related to nonunion.

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Clinical study of Masquelet technique in the treatment of osteomyelitis and bone defect

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20213374 ◽

2021 ◽

Vol 7 (5) ◽

pp. 901

Author(s):

Bikash Neupane ◽

Zhao Meng ◽

Xu Sheng Kang ◽

Prabha Paudel ◽

Sagar Panthi ◽

...

Keyword(s):

Bone Cement ◽

Bone Defect ◽

Prospective Observational Study ◽

Filling Defect ◽

Masquelet Technique ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Radical Debridement ◽

The Mean ◽

Methods Of Treatment

Background: The induced membrane technique, introduced by Masquelet in 1986 called Masquelet technique is universally preferred methods of treatment in bone defect either of any cause. Consists of two principle steps: first radical debridement and filling defect with polymethylmethacrylate (PMMA) spacer, this allows the formation of induction membrane. Secondly bone cement is removed and defect is filled with bone graft and stabilized with definitive fixation.Methods: This prospective observational study was carried out in the department of orthopedic surgery, Taihe Hospital affiliated to Hubei University of Medicine, Shiyan Hubei China from July 2018 to November 2019.Results: Total 32 patients observed and recorded for the analysis. The mean age 38.28±11.211 years. 20 (62.5%) male and 12 (37.5%) female, 13 (40.6%) had right, and 19 (59.4%) had left side injury. Tibia has the highest involvement 16 (50%), femur 10 (31.3%), calcaneus 3 (9.4%) radius, cuboid and ulna 1 (3.1%) each. For cause of defect osteomyelitis is found to have highest frequency of 11 (34.4%). The size of defect ranges from 3 to 20 cm with mean defect (6.91±4.489 cm). Duration of bone cement ranges from 4-20 weeks with mean of 8.75±3.379 weeks. The union time ranges from 4-14 months. With mean of 8.31±2.17 months. 18 (56.3%) have excellent results, 13 (40.6%) have good results, and 1 patient (3.1%) have satisfactory results.Conclusions: This study concludes that Masquelet technique as being the more appropriate, reliable and is a noble technique in the reconstruction of bone defect either of any cause with good functional result.

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