Innovative strategies for the management of long bone infection: a review of the Masquelet technique

Patient Safety in Surgery

Cyril Mauffrey³  Mark Hake²  Vivek Chadayammuri¹ 

[1] University of Colorado School of Medicine, Aurora, CO, USA;Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA;Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, 777 Bannock Street, Denver 80204, CO, USA

关键词: Fixation;    ORIF;    Antibiotic;    Masquelet;    Reconstruction;    Diaphyseal;    Defects;    Posttraumatic;    Osteomyelitis;   

Others  :  1231196
DOI  :  10.1186/s13037-015-0079-0

 received in 2015-07-31, accepted in 2015-10-05,  发布年份 2015

【 摘 要 】

Post-traumatic long bone osteomyelitis (PTOM) is a relatively frequent occurrence in patients with severe open fractures and requires treatment to prevent limb-threatening complications. The Masquelet technique represents a length-independent, two-staged reconstruction that involves the induction of a periosteal membrane and use of an antibiotic-impregnated cement spacer for the treatment of segmental bone loss that result from bone infection. In this review, we summarize recent developments regarding the diagnosis and treatment of long bone PTOM, with a special emphasis on the use of the Masquelet technique for reconstruction of wide diaphyseal defects.

【 授权许可】

   
2015 Chadayammuri et al.

【 图 表 】

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【 参考文献 】

• [1]Gallie WE. First recurrence of osteomyelitis eighty years after infection. J Bone Joint Surg Br. 1951; 33-b(1):110-1.
• [2]Patzakis MJ, Zalavras CG. Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts. J Am Acad Orthop Surg. 2005; 13(6):417-27.
• [3]Calhoun JH, Manring MM, Shirtliff M. Osteomyelitis of the long bones. Semin Plast Surg. 2009; 23(2):59-72.
• [4]Ikpeme IA, Ngim NE, Ikpeme AA. Diagnosis and treatment of pyogenic bone infections. Afr Health Sci. 2010; 10(1):82-8.
• [5]Sanders J, Mauffrey C. Long bone osteomyelitis in adults: fundamental concepts and current techniques. Orthopedics. 2013; 36(5):368-75.
• [6]Hake ME, Oh JK, Kim JW, Ziran B, Smith W, Hak D et al.. Difficulties and challenges to diagnose and treat post-traumatic long bone osteomyelitis. Eur J Orthop Surg Traumatol. 2015; 25(1):1-3.
• [7]Sanders JO, Bozic KJ, Glassman SD, Jevsevar DS, Weber KL. Clinical practice guidelines: their use, misuse, and future directions. J Am Acad Orthop Surg. 2014; 22(3):135-44.
• [8]Palmer MP, Altman DT, Altman GT, Sewecke JJ, Ehrlich GD, Hu FZ et al.. Can we trust intraoperative culture results in nonunions? J Orthop Trauma. 2014; 28(7):384-90.
• [9]Palmer M, Costerton W, Sewecke J, Altman D. Molecular techniques to detect biofilm bacteria in long bone nonunion: a case report. Clin Orthop Relat Res. 2011; 469(11):3037-42.
• [10]Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg. 2009; 23(2):80-9.
• [11]Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J Bone Joint Surg Am. 2004; 86-a(10):2305-18.
• [12]Brinker MR, O'Connor DP, Monla YT, Earthman TP. Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma. 2007; 21(8):557-70.
• [13]Mauffrey C, Barlow BT, Smith W. Management of Segmental Bone Defects. J Am Acad Orthop Surg. 2015; 23(3):143-153.
• [14]Pollak AN, McCarthy ML, Burgess AR. Short-term wound complications after application of flaps for coverage of traumatic soft-tissue defects about the tibia. The Lower Extremity Assessment Project (LEAP) Study Group. J Bone Joint Surg Am. 2000; 82-a(12):1681-91.
• [15]Dinh P, Hutchinson BK, Zalavras C, Stevanovic MV. Reconstruction of osteomyelitis defects. Seminars in plastic surgery. 2009; 23(2):108-18.
• [16]Hertel R, Gerber A, Schlegel U, Cordey J, Ruegsegger P, Rahn BA. Cancellous bone graft for skeletal reconstruction. Muscular versus periosteal bed--preliminary report. Injury. 1994;25 Suppl 1:A59-70.
• [17]Weiland AJ, Moore JR, Daniel RK. The efficacy of free tissue transfer in the treatment of osteomyelitis. J Bone Joint Surg Am. 1984; 66(2):181-93.
• [18]Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R. Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury. 2011; 42(6):591-8.
• [19]Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am. 2010; 41(1):27-37.
• [20]Mauffrey C, Chaus GW, Butler N, Young H. MR-compatible antibiotic interlocked nail fabrication for the management of long bone infections: first case report of a new technique. Patient Saf Surg. 2014; 8(1):14. BioMed Central Full Text
• [21]Meyer J, Piller G, Spiegel CA, Hetzel S, Squire M. Vacuum-mixing significantly changes antibiotic elution characteristics of commercially available antibiotic-impregnated bone cements. J Bone Joint Surg Am. 2011; 93(22):2049-56.
• [22]Kim JW, Cuellar DO, Hao J, Seligson D, Mauffrey C. Custom-made antibiotic cement nails: a comparative study of different fabrication techniques. Injury. 2014; 45(8):1179-84.
• [23]DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg. 2004; 12(1):28-38.
• [24]Wasko MK, Borens O. Antibiotic cement nail for the treatment of posttraumatic intramedullary infections of the tibia: midterm results in 10 cases. Injury. 2013; 44(8):1057-60.
• [25]Hake ME, Young H, Hak DJ, Stahel PF, Hammerberg EM, Mauffrey C. Local antibiotic therapy strategiesin orthopaedic trauma: Practical tips and tricks and review of the literature. Injury. 2015;46(8):1447-56.
• [26]Anagnostakos K, Furst O, Kelm J. Antibiotic-impregnated PMMA hip spacers: Current status. Acta Orthop. 2006; 77(4):628-37.
• [27]Chang Y, Tai CL, Hsieh PH, Ueng SW. Gentamicin in bone cement: A potentially more effective prophylactic measure of infectionin joint arthroplasty. Bone Joint Res. 2013; 2(10):220-6.
• [28]Adams K, Couch L, Cierny G, Calhoun J, Mader JT. In vitro and in vivo evaluation of antibiotic diffusion from antibiotic-impregnated polymethylmethacrylate beads. Clin Orthop Relat Res. 1992; 278:244-52.
• [29]Penner MJ, Duncan CP, Masri BA. The in vitro elution characteristics of antibiotic-loaded CMW and Palacos-R bone cements. J Arthroplasty. 1999; 14(2):209-14.
• [30]Wahlig H, Dingeldein E, Bergmann R, Reuss K. The release of gentamicin from polymethylmethacrylate beads. An experimental and pharmacokinetic study. J Bone Joint Surg Br. 1978; 60-B(2):270-5.
• [31]Hsieh PH, Chen LH, Chen CH, Lee MS, Yang WE, Shih CH. Two-stage revision hip arthroplasty for infection with a custom-made, antibiotic-loaded, cement prosthesis as an interim spacer. J Trauma. 2004; 56(6):1247-52.
• [32]Pelissier P, Boireau P, Martin D, Baudet J. Bone reconstruction of the lower extremity: complications and outcomes. Plast Reconstr Surg. 2003; 111(7):2223-9.
• [33]Kirkby K, Wheeler J, Farese J, Ellison G, Bacon N, Sereda C et al.. Surgical views: Vacuum-assisted wound closure: application and mechanism of action. Compend Contin Educ Vet. 2009; 31(12):E1-5-E7.
• [34]Tan Y, Wang X, Li H, Zheng Q, Li J, Feng G et al.. The clinical efficacy of the vacuum-assisted closure therapy in the management of adult osteomyelitis. Arch Orthop Trauma Surg. 2011; 131(2):255-9.
• [35]Large TM, Douglas G, Erickson G, Grayson JK. Effect of negative pressure wound therapy on the elution of antibiotics from polymethylmethacrylate beads in a porcine simulated open femur fracture model. J Orthop Trauma. 2012; 26(9):506-11.
• [36]Bouachour G, Cronier P, Gouello JP, Toulemonde JL, Talha A, Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: a randomized double-blind placebo-controlled clinical trial. J Trauma. 1996; 41(2):333-9.
• [37]Apard T, Bigorre N, Cronier P, Duteille F, Bizot P, Massin P. Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res. 2010; 96(5):549-53.
• [38]Henrich D, Seebach C, Nau C, Basan S, Relja B, Wilhelm K, et al. Establishment and characterization ofthe Masquelet induced membrane technique in a rat femur critical-sized defect model. Journal of tissue engineering and regenerative medicine. 2013. doi:10.1002/term.1826
• [39]Pelissier P, Masquelet AC, Bareille R, Pelissier SM, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res. 2004; 22(1):73-9.
• [40]Zwetyenga N, Catros S, Emparanza A, Deminiere C, Siberchicot F, Fricain JC. Mandibular reconstruction using induced membranes with autologous cancellous bone graft and HA-betaTCP: animal model study and preliminary results in patients. International journal of oral and maxillofacial surgery. 2009; 38(12):1289-97.
• [41]Kovar FM, Wozasek GE. Bone graft harvesting using the RIA (reaming irrigation aspirator) system - a quantitative assessment. Wien Klin Wochenschr. 2011; 123(9-10):285-90.
• [42]Masquelet AC, Benko PE, Mathevon H, Hannouche D, Obert L. Harvest of cortico-cancellous intramedullary femoral bone graft using the Reamer-Irrigator-Aspirator (RIA). Orthop Traumatol Surg Res. 2012; 98(2):227-32.
• [43]Van Gorp CC, Falk JV, Kmiec SJ, Siston RA. The reamer/irrigator/aspirator reduces femoral canal pressure in simulated TKA. Clin Orthop Relat Res. 2009; 467(3):805-9.
• [44]Porter RM, Liu F, Pilapil C, Betz OB, Vrahas MS, Harris MB et al.. Osteogenic potential of reamer irrigator aspirator (RIA) aspirate collected from patients undergoing hip arthroplasty. J Orthop Res. 2009; 27(1):42-9.
• [45]Sagi HC, Young ML, Gerstenfeld L, Einhorn TA, Tornetta P. Qualitative and quantitative differences between bone graft obtained from the medullary canal (with a Reamer/Irrigator/Aspirator) and the iliac crestof the same patient. J Bone Joint Surg Am. 2012; 94(23):2128-35.
• [46]Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res. 2012; 98(1):97-102.
• [47]Giannoudis PV, Einhorn TA. Bone morphogenetic proteins in musculoskeletal medicine. Injury. 2009; 40 Suppl 3:S1-3.
• [48]Bosemark P, Perdikouri C, Pelkonen M, Isaksson H, Tagil M. The Masquelet Induced Membrane Technique with BMP and a Synthetic Scaffold Can Heal a Rat Femoral Critical Size Defect. J Orthop Res. 2015; 33(4):488-95.
• [49]Stafford PR, Norris BL. Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: a review of 25 cases. Injury. 2010; 41 Suppl 2:S72-7.