Masquelet technique in management of infective non-union of long bones- A prospective study

Introduction and Aim: Masquelet’s technique is a 2-staged procedure, for treatment of infected segmental bone defect. 1st stage involves radical debridement with antibiotic-induced cement spacer. During second stage, the spacer is removed and the autologous bone graft is applied into the biomembrane formed. In this study, we evaluate the Masquelet’s technique for the management of infective non-union of long bones. Materials and Methods: 15 patients with infective non-union of long bones- tibia, femur and a case of congenital pseudoarthrosis of tibia, were treated with Masquelet’s technique. They underwent 2 stages of procedures 6-8 weeks apart and was followed up for about 9 months and radiological and clinical outcomes were assessed. Results: Out of 15 patients with infective non-union, 8 patients attained union. Out of the 7 patients with failure of the technique, higher failure rates were attributed to Pseudomonas infection. Conclusion: Masquelet’s technique is a cost-effective method for treating infective segmental non-unions, not requiring special training or sophisticated instruments. This method shows good results with Gram positive infections. Although, the outcome with Pseudomonas aeruginosa infection, have not shown satisfactory results.

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A Prospective Study of a Cost-Effective Method for Prevention of Incisional Hernia in Subcostal and Lumbar Incisions by Use of Nylon Loop, Intermittent Mass Closure

New Indian Journal of Surgery ◽

10.21088/nijs.0976.4747.9618.3 ◽

2018 ◽

Vol 9 (6) ◽

pp. 712-714

Author(s):

Shah Bhavin K ◽

Keyword(s):

Incisional Hernia ◽

Prospective Study ◽

Cost Effective ◽

Mass Closure ◽

Cost Effective Method ◽

A Prospective Study

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Management of uncontained bone voids with Calcium Sulphate Ceramic (Modified Masquelet / Modified AMIC with Cerament Bio-Composite) Case report and review of literature

Surgical Case Reports ◽

10.31487/j.scr.2019.04.07 ◽

2019 ◽

pp. 1-3

Author(s):

Ahmed Aljawadi ◽

Mazin Al-salihy ◽

Anand Pillai ◽

Noman Niazi

Keyword(s):

Bone Graft ◽

Donor Site ◽

Calcium Sulphate ◽

Autologous Bone Graft ◽

Donor Site Morbidity ◽

First Case ◽

Masquelet Technique ◽

Autologous Bone ◽

Segmental Bone ◽

Bone Void

Introduction: Large traumatic bone voids are challenging to treat. Autografts are associated with donor site morbidity and limited availability. Bone graft substitutes are successful alternative to fill bone voids. Case Presentation: The management of two patients with an open tibial fracture with segmental bone loss and other patient with periarticular calcaneal void associated with chondral loss. Treatment and outcomes: For first case, a contained cavity was made using Septocoll E, an absorbable collagen fleece, to mimic a pseudo-membrane using Masquelet-technique. Bone void was filled with Cerament-G and autologous bone graft. Second case with large peri-articular calcaneal void and chondral loss, Cerament-G and autologous bone graft were used, and articular defect reconstruction was done with synthetic chondral tissue. Both patients had painless mobility and consolidation of bone void. Discussion: We represent two exceptional cases of traumatic bone void which were treated with modified masquelet/modified AMIC with Cerament Bio-Composite with satisfactory outcomes

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A Challenging Case of Limb Salvage Requiring a Combination of Composite Fixation and Masquelet Technique to Address Significant Segmental Bone Loss

Case Reports in Orthopedics ◽

10.1155/2015/369469 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

C. Blair ◽

A. T. Simela ◽

B. J. Cross

Keyword(s):

Bone Loss ◽

Limb Salvage ◽

Cement Spacer ◽

Skeletal Trauma ◽

Complex Issue ◽

Second Stage ◽

Considerable Success ◽

Masquelet Technique ◽

Antibiotic Spacer ◽

Segmental Bone

Cases of limb salvage following skeletal trauma involving significant bone loss pose a particular challenge to the reconstructive surgeon. Certain techniques for addressing this complex issue have been advanced in recent years and have met with considerable success. The Masquelet technique involves a staged procedure in which a temporary skeletal stabilization is paired with implantation of an antibiotic spacer and left in place for 6–8 weeks, during which time a “pseudomembrane” forms around the cement spacer. During the second stage of the procedure, the pseudomembrane is incised, the antibiotic spacer removed, and bone graft is placed. We present a case of significant segmental femur loss in a 19-year-old male opting for limb salvage in which a 17-centimeter segmental loss of bone was essentially regrown using a combination of the Masquelet technique with supplemental endosteal fixation.

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Management of twenty centimeter segmental bone defect of femoral shaft secondary to infected non-union of fracture using masquelet technique: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.106107 ◽

2021 ◽

pp. 106107

Author(s):

K. Kubes ◽

A. Friedman ◽

C. Pyle ◽

G. Diaz ◽

D. Hargett

Keyword(s):

Case Report ◽

Bone Defect ◽

Femoral Shaft ◽

Segmental Bone Defect ◽

Non Union ◽

Masquelet Technique ◽

Segmental Bone

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Use of Tantalum Trabecular Metal Cones for Management of Nonunion of the Distal Femur with Segmental Bone Defects: Technique and Case Series

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i07.2298 ◽

2021 ◽

Vol 11 (7) ◽

Author(s):

Alan W Reynolds ◽

Patricia R Melvin ◽

Eric J Yakish ◽

Nicholas Sotereanos ◽

Gregory T Altman ◽

...

Keyword(s):

Distal Femur ◽

Case Series ◽

Bone Defects ◽

Autologous Bone Graft ◽

Trabecular Metal ◽

Non Union ◽

Segmental Bone ◽

Keywords Femur ◽

Segmental Bone Defects

Introduction: Segmental bone loss in the distal femur presents a challenge for reconstruction regardless of etiology. Use of tantalum trabecular metal cones with intramedullary fixation and autologous bone graft may be used as a salvage technique in difficult situations where other options have either been exhausted or are unavailable. Case Report: Surgical planning and technique for this approach to reconstruction are described. A retrospective review of five cases with >1 year of follow-up was performed to provide radiographic and clinical outcomes. All five patients had satisfactory outcomes with clinical union and retention of implants at final follow-up (average >4 years). Conclusions: Use of tantalum metal cones for reconstruction of distal femur nonunion with segmental bone defects can be a successful technique in a complex group of patients. Keywords: Femur, bone defect, non-union, induced membrane, tantalum.

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Outcome of Tibio-talo-calcaneal Arthrodesis using Supracondylar Femoral Intramedullary Interlocking Nail

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1065 ◽

2017 ◽

Vol 4 (1) ◽

pp. 23-29

Author(s):

S Hiranya kumar ◽

Praneeth Revuri ◽

Ashish D Shah

Keyword(s):

Weight Bearing ◽

Cost Effective ◽

Delayed Union ◽

Intramedullary Fixation ◽

Asia Pacific ◽

Interlocking Nail ◽

Cost Effective Method ◽

Excellent Method ◽

A Prospective Study ◽

Patients Experience

ABSTRACT Introduction Tibiotalar arthritis of foot is a progressive pathology; if left untreated, patients experience excruciating pain at every step while walking/weight bearing. The treatment depends on whether the pain is to be managed conservatively or surgically. This article is intended for the description of a technique performing tibiotalocalcaneal arthrodesis (TTCA) using an indigenous femur supracondylar nail, an intramedullary fixation. Materials and methods This article contains a prospective study of 21 patients with a mean age of 46 years, males — 13 and females — 8, who underwent TTCA with intramedullary fixation for the diagnoses of osteoarthrosis (6 patients), rheumatoid arthritis (6 patients), and arthritis secondary to avascular necrosis (AVN) of talus/trauma (9 patients), with a mean follow-up interval of 22 months. Results Out of 21 patients, 96.55% union rate was achieved at a mean time to union of 16 weeks, with one patient (3.45%) going for delayed union. Conclusion Intramedullary nailing is an excellent method of fixation for TTCA in the appropriately selected patients. Using an indigenous supracondylar femoral nail is a cost-effective method, and this gave equivalent results as that of other intramedullary nails in properly selected patients. How to cite this article Hiranyakumar S, Revuri P, Shah AD. Outcome of Tibio-talo-calcaneal Arthrodesis using Supracondylar Femoral Intramedullary Interlocking Nail. J Foot Ankle Surg (Asia-Pacific) 2017;4(1):23-29.

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MANAGEMENT OF INFECTED FRACTURE NON-UNION OF LONG BONES BY MASQUELET TECHNIQUE IN PATIENTS WITH BONE LOSS LESS THAN 4 CM

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2018/834 ◽

2018 ◽

Vol 7 (33) ◽

pp. 3715-3720

Author(s):

Bellary Mohammed Ghouse ◽

Koti Satish ◽

Buchireddy Jayachandra Reddy ◽

Zeeshan Mujahid

Keyword(s):

Bone Loss ◽

Long Bones ◽

Non Union ◽

Masquelet Technique

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PLATELET COUNT: A PROGNOSTIC INDICATOR IN PREECLAMPSIA AND ECLAMPSIA

10.36106/5023430 ◽

2021 ◽

pp. 73-75

Author(s):

Naveed Tamboli ◽

Hemant Murdeshwar ◽

Gulafroz Sk Samad

Keyword(s):

Platelet Count ◽

Bleeding Time ◽

Management Strategies ◽

Cost Effective ◽

Prognostic Indicator ◽

Fetal Outcome ◽

Clotting Time ◽

Cost Effective Method ◽

Induced Hypertension ◽

A Prospective Study

Introduction: Hypertensive disorders of pregnancy is one of the major complications of pregnancy. It forms the fatal triad along with the haemorrhage and infection that contributes greatly to fetal and maternal morbidity and mortality.Of the various parameters used, platelet count is the most simple and cost effective method for prediction of PIH(Pregnancy induced hypertension).This study soughts the importance of platelet count as the most consistent and reliable method in early detection of PIH cases. Materials and methods: A prospective study was conducted on 164 cases and 70 controls over a period of 2 years. The bleeding time, clotting time, hemoglobin estimation and platelet count were performed.The patients were classied into mild preeclamptic, severe preeclamptic and eclamptic based on the clinical and haematological parameters. Observations: The platelet count in severe preeclampsia and eclampsia was signicantly lower than in mild pre eclampsia and controls. Thrombocytopenia was seen in total 35 cases of severe pre-eclampsia and eclampsia combined,out of which 30 (85.7%) had poor maternal outcome and 34 (97.1%) poor fetal outcome. Conclusion:The frequency of thrombocytopenia is found to be directly related with the severity of disease. So routine test like platelet count can be used as a simple and cost effective tool to monitor the progression of preeclampsia and and plan preemptive management strategies that has been proven to have a crucial role in reducing the morbidity and mortality of both mother and fetus

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Pharmacoeconomic Analysis of Cefmenoxime Dual Individualization in the Treatment of Nosocomial Pneumonia

Annals of Pharmacotherapy ◽

10.1177/106002809402800316 ◽

1994 ◽

Vol 28 (3) ◽

pp. 384-389 ◽

Cited By ~ 21

Author(s):

Joseph A. Paladino ◽

Robert E. Fell

Keyword(s):

Sensitivity Analysis ◽

Cost Effectiveness ◽

Length Of Stay ◽

Pharmacoeconomic Analysis ◽

Hospital Costs ◽

Cost Effective ◽

Total Hospital ◽

Similar Reduction ◽

Cost Effective Method ◽

A Prospective Study

OBJECTIVE: To determine if dual individualization of cefmenoxime dosing is cost-effective. DESIGN: Retrospective, pharrnacoeconomic decisionanalysis of two consecutively conductedprospective clinical studies. PATIENTS: Patientswithdocumentedgram-negative nosocomial pneumoniawere evaluated. Thirty-three patients received cefmenoximeat standarddosing and 28 patients received doses according to dual individualization methodology. MAIN OUTCOME MEASURE: Antibiotic and infection-related costs were compared between groups. The number of hospital antibiotic days and costs incurred on those days were also evaluated. A decision model was constructed to characterize differences in treatment outcome. Probabilities with in the decision tree were derived from 61 evaluable patients. Cost-effectiveness and incremental cost-effectiveness ratios were calculated. Sensitivity analysis was performed by varying out come probabilities, antibiotic prices, and hospital room costs. RESULTS: Antibiotic and infection-related costs (mean ± SEM) were $848 ± 78 for standard cefmenoxime dosing and $1123 ± 128 for dual individualization (p<0.05). Total hospital costs were $10 660 ± 1432 or standard dosing and $11 700 ± 1900 for dual individualization (p>0.05). Median antibiotic length of stay (ALOS) was 15.2 and 12.7 days for standard and dual individualization methodologies, respectively (p>0.05). Incremental analysis of cost effectiveness indicated that a similar reduction in length of stay for 259 dual individualization patients would save $321 808 annually. CONCLUSIONS: Sensitivity analysis indicates that by reducing ALOS, dual individualization could be a cost-effective method of betalactam dosing for patients with pneumonia. A prospective study should be conducted to validate these findings.

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