Comparison of the clinical outcomes between vascularized bone graft and the Masquelet technique for the reconstruction of Gustilo type III open tibial fractures

BMC Musculoskeletal Disorders

Research

Yi-Hsun Yu¹  Cheng-Hung Lin²  Shih-Heng Chen²  Ching-Yu Lan²  Chung-Cheng Hsu²  Po-Hao Lien²  Yu-Te Lin²  Chih-Hung Lin² 

[1] Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Chang Gung University and Medical College, 5, Fu-Hsin St. Kweishan, 33302, Taoyuan, Taiwan;Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University and Medical College, Fu-Hsin St. Kweishan, 33302, Taoyuan, Taiwan;

关键词: Open tibial fracture;    Bone defect;    Vascularized bone graft;    Masquelet technique;    Induced membrane technique;    Union time;    Infection;   

DOI  :  10.1186/s12891-022-06010-4

 received in 2022-05-29, accepted in 2022-11-22,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundGustilo type III tibial fractures commonly involve extensive soft tissue and bony defects, requiring complex reconstructive operations. Although several methods have been proposed, no research has elucidated the efficacies and differences between vascular bone graft (VBG) and the Masquelet technique (MT) to date. We aimed to evaluate and compare the clinical effectiveness of VBG and the MT for the reconstruction of Gustilo type III tibial fractures.MethodsThis retrospective cohort study enrolled patients who underwent reconstruction for Gustilo type III tibial fractures using VBG or the MT in a single center from January 2000 to December 2020. The patients’ demographics, injury characteristics, and surgical interventions were documented for analysis. The clinical outcomes including union status, time to union, postoperative infections, and the causes of union failure were compared between the two groups.ResultsWe enrolled 44 patients: 27 patients underwent VBG, and 17 underwent MT. The average union time was 20.5 ± 15.4 and 15.1 ± 9.0 months in the VBG and MT groups, respectively (p = 0.232). The postoperative deep infection rates were 70.4% and 47.1% in the VBG and MT groups (p = 0.122), respectively. Though not statistically significant, the VBG group had a shorter union time than did the MT group when the bone defect length was > 60 mm (21.0 ± 17.0 versus 23.8 ± 9.4 months, p = 0.729), while the MT group had a shorter union time than did the VBG group when the bone defect was length < 60 mm (17.2 ± 5.6 versus 10.7 ± 4.7 months, p = 0.067).ConclusionsVBG and MT are both promising reconstruction methods for Gustilo type III tibial fractures. VBG appears to have more potential in reconstructing larger bone defects, while MT may play an important role in smaller bone defects, severe surgical site infections, and osteomyelitis. Therefore, flexible treatment strategies are required for good outcomes in Gustilo type III open tibial fractures.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

Fig. 7