Infected bone defects in the lower limb. Management by means of a two-stage distraction osteogenesis protocol

3D-printed titanium porous prosthesis combined with the Masquelet technique for the management of large femoral bone defect caused by osteomyelitis

BACKGROUND

The treatment of infected bone defects remains a clinical challenge. With the development of three-dimensional printing technology, three-dimensional printed implants have been used for defect reconstruction. The aim of this study was to investigate the clinical outcomes of three-dimensional printed porous prosthesis in the treatment of femoral defects caused by osteomyelitis.

METHODS

Eleven patients with femoral bone defects following osteomyelitis who were treated with 3D-printed porous prosthesis at our institution between May 2017 and July 2021, were included. Eight patients were diagnosed with critical-sized defects, and the other three patients were diagnosed with shape-structural defects. A two-stage procedure was performed for all patients, and the infection was eradicated and bone defects were occupied by polymethylmethacrylate spacer during the first stage. The 3D-printed prosthesis was designed and used for the reconstruction of femoral defects in the second stage. Position of the reconstructed prostheses and bone growth were measured using radiography. The union rate, complications, and functional outcomes at the final follow-up were assessed.

RESULTS

The mean length of the bone defect was 14.0 cm, union was achieved in 10 (91%) patients. All patients showed good functional performance at the most recent follow-up. In the critical-sized defect group, one patient developed a deep infection that required additional procedures. Two patients had prosthetic dislocations. Radiography demonstrated good osseous integration of the implant-bone interface in 10 patients.

CONCLUSION

The 3D printed prostheses enable rapid anatomical and mechanically stable reconstruction of extreme femur bone defects, effectively shortens treatment time, and achieves satisfactory clinical outcomes.

First-ever ankle arthrodesis with the Capanna technique in an infected open fracture

Although bone transport by means of distraction osteogenesis has become the standard of care for massive segmental bone defects, the technique faces limitations such as the lengthy period of time during which patients must wear an external fixator. Thus, other techniques may be more appropriate in certain circumstances. Capanna developed a combination of vascularized fibular grafts and strut allografts in a way that the strut allograft provides with significant initial mechanical stability, which facilitates incorporation of a vascularized fibular graft and promotes long-term survival of the reconstruction. The case presented in this report is the first in the medical literature where a circular external fixator is used as a stabilization method in a patient with a structural bone deficiency treated by means of the Capanna technique. It is also one of the few reported cases where the underlying condition does not originate in a tumor and where the joint is involved.