1
|
Du Y, Yu C, Peng Z, Lv Y, Ta W, Lu S. Masquelet technique combined with modified Sauve‑Kapandji, negative pressure drainage and flap transplantation for the treatment of a Gustilo‑Anderson III type C open fracture of the forearm: A case report. Exp Ther Med 2022; 24:610. [PMID: 36160899 PMCID: PMC9468799 DOI: 10.3892/etm.2022.11546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023] Open
Abstract
Gustilo-Anderson III Type C open fracture is a high-energy injury with severe bone defects and extensive soft-tissue and vascular damage. Successful limb salvage remains challenging for surgeons due to the inherent risks of vascular damage, infection, nonunion and even amputation. The present case study reports on a 55-year-old male who presented with a Gustilo-Anderson III type C open fracture, which was successfully salvaged by a combined Masquelet and microsurgical approach. The modified Sauve-Kapandji technique was used to improve wrist mobility. Sufficient preoperative evaluation, a detailed surgical plan, positive revascularization, thorough debridement and prevention of complications are key to successful limb salvage. The range of motion test was excellent one year after surgery. The patient was able to take care of their daily life, return to performing a light-labor job and is satisfied with the function of the limb. Therefore, the Masquelet technique combined with modified Sauve-Kapandji technique, negative pressure drainage and skin-flap transplantation may be a reasonable and effective treatment for Gustilo-Anderson III type C open forearm fracture.
Collapse
Affiliation(s)
- Yongjun Du
- Medical School, Kunming University of Science and Technology, Kunming, Yunnan 650500, P.R. China
| | - Chen Yu
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan 650034, P.R. China
| | - Zhi Peng
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan 650034, P.R. China
| | - Yan Lv
- Medical School, Kunming University of Science and Technology, Kunming, Yunnan 650500, P.R. China
| | - Wufei Ta
- Department of Orthopedics, Kunming 311 Hospital, Kunming, Yunnan 650100, P.R. China
| | - Sheng Lu
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan 650034, P.R. China
| |
Collapse
|
2
|
Aljawadi A, Naylor T, Islam A, Madhi I, Niazi N, Elmajee M, Pillai A. Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in the Management of Patients With Traumatic Bone Voids. Cureus 2022; 14:e20969. [PMID: 35154948 PMCID: PMC8815800 DOI: 10.7759/cureus.20969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/06/2022] Open
Abstract
Background Management of traumatic bone voids has always been challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) showed encouraging results in achieving good bone healing with a satisfactory degree of resorption when utilised as a void filler. This study aims to assess the radiological signs of Cerament-G remodelling when used for patients with traumatic bone voids. Methods Retrospective data analysis of all patients admitted to our unit between 2015 and 2021 with traumatic bone voids who had Cerament-G applied intraoperatively as a void filler. Postoperative radiographic images of the fracture site at six weeks, three months, six months, and at the final follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing at the final follow-up were assessed. Results A total of 51 patients (52 fractures) were included in the study. Among them 10 were female and 41 were male with a mean age of 42.7 (11 - 90) years. The mean void size was 6.58 cm3. Mean follow-up duration was 9.73 months. Primary fracture union was achieved in 44 (86.3%) patients. Delayed union was reported in six (11.7%) patients, while one (1.9%) patient had non-union. Twenty-seven (52%) patients had >90% of void healing with normal trabecular bone. Twenty (38.5%) patients had 50-90% void healing with normal bone. Whereas only five (9.5%) patients had less than 50% of void healing. Conclusion Cerament-G used as a void filler for patients with traumatic bone void has resulted 98% fracture union rate with good signs of radiological remodelling into a trabecular bone. More than 50% void filling with new trabecular bone was reported in more than 90% of patients. Non-union was reported in only one patient.
Collapse
Affiliation(s)
- Ahmed Aljawadi
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR
| | - Thomas Naylor
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR
| | - Amirul Islam
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR
| | - Imad Madhi
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR
| | - Noman Niazi
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR
| | - Mohammed Elmajee
- Trauma and Orthopaedics, Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, GBR
| | - Anand Pillai
- Trauma and Orthopaedics, Wythenshawe Hospital, Manchester, GBR
| |
Collapse
|
3
|
Miraj F, Nugroho A, Dalitan IM, Setyarani M. The efficacy of ilizarov method for management of long tibial bone and soft tissue defect. Ann Med Surg (Lond) 2021; 68:102645. [PMID: 34401130 PMCID: PMC8350182 DOI: 10.1016/j.amsu.2021.102645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Patients with open fracture Gustillo-Anderson grade 3 had undergone several surgical procedures, but still ended up with expose long dead bone or infected. Illizarov method was used to address long bone and soft tissue defect after re-debridement with radical resection of long dead bone or infected segment. METHODS We included 14 patients (mean age: 30.86 ± 11.49) with non-union tibial fracture with long dead and infected bone segment who had undergone several debridement, bone grafting or spacer and soft tissue closure procedure due to open fracture of tibia grade 3. The subjects underwent re-debridement with radical resection of dead or infected bone segment followed by Illizarov method to perform bone transport procedure for bone defect filling and simultaneously restore severe soft tissue loss and bone lengthening procedure. RESULTS All subjects had achieved satisfactory results with mean docking period of bone transport 3.78 ± 0.54 months, union time at the docking side 7 (5.5-9) months. Soft tissue was covered and no recurrence of infection. Three subjects had Leg Length Discrepancy (LLD) of 1 cm, whereas the remaining had zero discrepancy. No significant pain was observed at final follow-up and 4 patients had ankle joint stiffness. CONCLUSION The Illizarov method can effectively address long bone and soft tissue defects by distraction osteogenesis through bone transport procedure that filling the defect gradually without bone graft and simultaneously enhancing soft tissue closure without tertiary soft tissue procedure subsequently followed with bone lengthening procedure to correct the limb length discrepancy.
Collapse
Affiliation(s)
- Faisal Miraj
- Pediatrics Orthopaedics and Limb Reconstruction Division, Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Ahmad Nugroho
- Resident of Orthopaedics and Traumatology Department, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia/ Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ivan Mucharry Dalitan
- Resident of Orthopaedics and Traumatology Department, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia/ Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Melitta Setyarani
- Resident of Orthopaedics and Traumatology Department, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia/ Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
4
|
Modified Masquelet Technique Using Allogeneic Graft for a Gustilo-Anderson Type III-A Open Fracture of the Femur with an 8 cm Bone Defect. Case Rep Orthop 2021; 2021:8829158. [PMID: 33777470 PMCID: PMC7979282 DOI: 10.1155/2021/8829158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 01/18/2023] Open
Abstract
The induced membrane technique was initially described by Masquelet et al. in 1986 as a treatment for tibia nonunion; then, it became one of the established methods in the management of bone defects. Several changes have been made to this technique and have been used in different contexts and different methodologies. We present the case of a 16-year-old girl admitted to our department for a polytrauma after a motorcycle accident. She presented a Gustilo III-A open fracture of the right femoral shaft with a large bone defect of 8 centimeters that we treated with a modified Masquelet technique. In the first stage, an Open Reduction and Internal Fixation of the fracture was made using a 4,5 mm Dynamic Compression Plate and a PMMA cement was inserted at the bone defect area. The second stage was done after 11 weeks, and the defect area was filled exclusively with bone allograft from a bone bank. Complete bony union was seen at 60 weeks of follow-up. After the removal of the implants by another surgeon, the patient presented an atraumatic fracture of the neoformed bone that we treated with intramedullary femoral nailing associated with a local autograft using reaming debris. A complete bony union was achieved after 12 weeks with a complete range of motion of the hip and knee. The stability given to the fracture is essential because it influences the quality of the induced membrane and Masquelet has recommended high initial fixation rigidity to promote incorporation of the graft. It is recommended to delay the second stage of this technique after 8 weeks, especially in femoral reconstruction, to optimize the quality of the induced membrane. Several studies used a modified induced membrane technique to recreate a traumatic large bone defect, and all of them used an autologous bone graft alone or an enriched bone graft. In this case, the use of allograft exclusively seems to be as successful as an autologous or enriched bone graft. Now, with the advent of bone banks, it is possible to get an unlimited amount of allograft, so additional research and large studies are necessary before giving recommendations.
Collapse
|
5
|
Prada C, Marcano-Fernández FA, Schemitsch EH, Bzovsky S, Jeray K, Petrisor B, Bhandari M, Sprague S. Timing and Management of Surgical Site Infections in Patients With Open Fracture Wounds: A Fluid Lavage of Open Wounds Cohort Secondary Analysis. J Orthop Trauma 2021; 35:128-135. [PMID: 33105456 DOI: 10.1097/bot.0000000000001912] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Many studies report on the incidence or prevalence of fracture-related surgical site infections (SSIs) after open fractures; however, few studies report on their timing and management outcomes. To address this gap, we used data from the Fluid Lavage of Open Wounds trial to determine timing of diagnosis, management, and resolution of SSIs. METHODS All participants included in this analysis had an SSI after an open fracture. Participants were assigned to a group based on the type of SSI as follows: (1) those who developed a superficial SSI and (2) those who had either a deep or organ/space SSI. Descriptive statistics characterized the type, timing, and management of each SSI. RESULTS Of the 2445 participants in the Fluid Lavage of Open Wounds trial, 325 (13.3%) had an SSI. Superficial SSIs were diagnosed significantly earlier [26.5 days, interquartile range (IQR) 12-48] than deep or organ/space SSIs (53 days, IQR 15-119). Of the 325 patients with SSIs, 174 required operative management and 151 were treated nonoperatively. For SSIs managed operatively, median time for infection resolution was 73 days (IQR 28-165), and on average, 1.73 surgeries (95% confidence interval 1.58-1.88) were needed during the 12 months follow-up. There were 24 cases whose SSIs were not resolved at the time of the final follow-up visit (12 months). CONCLUSIONS Based on this study's findings and in contradistinction to the Centers for Disease Control and Prevention guidelines, after an open fracture, superficial SSIs were diagnosed at one month and deep/organ/space SSIs at 2 months. This information can allow for earlier infection detection. In addition, the knowledge that approximately 50% of the SSIs in our study required a reoperation and 3 months at a minimum to resolve will assist orthopaedic surgeons when counseling their patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Carlos Prada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Francesc A Marcano-Fernández
- Orthopaedic Department, Parc Taulí Hospital Universitari, Institut D'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Emil H Schemitsch
- Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kyle Jeray
- Department of Orthopaedic Surgery, Greenville Health System, Greenville, SC; and
| | - Brad Petrisor
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
6
|
Deng L, Yu A, Qi B, Lei J, De Souza C, Zhu S, Yu L. The Masquelet technique combined with the muscle flap for use in emergency management of acute Gustilo type III trauma of the lower limb with segmental bone loss:Case series. Int J Surg 2020; 81:85-93. [DOI: 10.1016/j.ijsu.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/05/2020] [Accepted: 07/08/2020] [Indexed: 01/09/2023]
|