Masquelet technique for management of posttraumatic bone defect in a patient of chronic osteomyelitis of long bone

<p class="abstract">Masquelet technique, which is the use of a temporary cement spacer followed by staged bone grafting, is a treatment strategy for reconstruction of large, infected, bone defects. This paper describes a patient treated with this technique to successfully manage postinfective or posttraumatic osseous long bone defect. Sequestrectomy was done and the injured limb was stabilized and aligned with application of external fixator at the time of initial antibiotic cement spacer placement. After 6 weeks of proper antibiotic coverage, all antibiotics were stopped for next 2 weeks. Clinical evaluation and investigations were done to rule out any residual infection. Osseous consolidation was successfully achieved with staged bone grafting and internal stabilization of long bone defect.</p>

Efficacy of free fibula flap for reconstruction of post traumatic long bone defect: retrospective study of eighteen cases

<p class="abstract"><strong>Background: </strong>Complex and segmental bone defects are common after resection of tumors and trauma involving long bones of the extremities. Free fibula flap is commonly practiced for complex oromandibular defects and bone reconstruction after sarcoma and bone tumor excision. But post traumatic bone reconstruction of extremities with free fubula is less commonly practiced and only reserved for long segmental reconstruction or as an alternative to distraction osteogenesis. We are presenting a retrospective analysis of surgical details and outcome of 18 cases with post traumatic long bone defect reconstructed with free fibula osteocutaneous flap.</p><p class="abstract"><strong>Methods:</strong> 18 patients with post traumatic composite or segmental long bone defect which were reconstructed with free fibula osteocutaneous flap (FFOCF) between 2014 to 2018 are included in this study. Operative details, success rate, bone healing, functional outcome and complications are reviewed retrospectively.<strong></strong></p><p class="abstract"><strong>Results:</strong> Success rate of flap surgery was 17/18 (94.44%). Bone gap was 6-17 cm and Skin paddle ranged from 10 cm × 8 cm to 15 cm × 10 cm. Bone healing, weight bearing outside cast and return to daily activity period were 8-16 weeks, 10-15 months and 12-18 months respectively. Non-union, malunion and stress fracture were noted in one,one and three patients respectively.</p><p class="abstract"><strong>Conclusions:</strong> Free fibula flap is a reliable method for reconstruction of post traumatic complex and segmental long bone defects. Quality of bone healing is good enabling resuming to early weight bearing and daily activities and high success rate. Free fibula flap may be procedure of choice for reconstruction of such bony injuries with the microvascular surgical facilities.</p>

Management of extra-articular segmental defects in long bone using a titanium mesh cage as an adjunct to other methods of fixation

Aims This study reviews the use of a titanium mesh cage (TMC) as an adjunct to intramedullary nail or plate reconstruction of an extra-articular segmental long bone defect. Patients and Methods A total of 17 patients (aged 17 to 61 years) treated for a segmental long bone defect by nail or plate fixation and an adjunctive TMC were included. The bone defects treated were in the tibia (nine), femur (six), radius (one), and humerus (one). The mean length of the segmental bone defect was 8.4 cm (2.2 to 13); the mean length of the titanium mesh cage was 8.3 cm (2.6 to 13). The clinical and radiological records of the patients were analyzed retrospectively. Results The mean time to follow-up was 55 months (12 to 126). Overall, 16 (94%) of the patients achieved radiological filling of their bony defect and united to the native bone ends proximally and distally, resulting in a functioning limb. Complications included device failure in two patients (12%), infection in two (12%), and wound dehiscence in one (6%). Four patients (24%) required secondary surgery, four (24%) had a residual limb-length discrepancy, and one (6%) had a residual angular limb deformity. Conclusion A titanium mesh cage is a useful adjunct in the treatment of an extra-articular segmental defect in a long bone. Cite this article: Bone Joint J 2018;100-B:646–51.