Outcomes of Infected Non-unions of Distal Femur Managed with the Masquelet Method and Ilizarov Ring Fixator.

IF 1.1 4区医学 Q3 ORTHOPEDICS

Indian Journal of Orthopaedics Pub Date : 2024-10-27 eCollection Date: 2024-12-01 DOI:10.1007/s43465-024-01279-0

Aradhana Rathod, Rameshkrishna Krishnamurthy, Deepak Shivanna, Putta Kempa Raju, Prabhu Manandi

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引用次数: 0

Abstract

Background: Distal femur infected non-union management is very challenging especially when there is late presentation and after multiple intervention. Various methods have been described and studied in the literature for infected non-union of femur which includes bone transport by fixators (ring fixators/monolateral frames) and by Masquelet method.

Objectives: To study the clinical and radiological outcomes and study the effect on quality of life by patient-reported outcomes (EQ5D5L) and VAS (Visual Analog Scale) score in patients of infected non-union of distal femur managed with combination of Masquelet method and Ilizarov ring fixator.

Patients and methods: Eleven patients aged between 18 and 60 years, both sexes, presenting with infected non-union of distal femur were considered for the study. Average findings were: time of presentation-56 weeks post-injury, number of previous surgeries-2.1, bone loss after debridement-8.5 cm, pre-operative VAS score-8.4, pre-operative EQ5D5L score-21.4, ISS-55.6, NUSS-56.54. Surgery was performed in two stages. Stage one involved debridement, application of a knee-spanning ring fixator, a vancomycin-loaded poly methyl methacrylate cement spacer, and closure, with corticotomy performed in some patients during this or the second stage.

Results: The three patients (27.3%) had graft infection and underwent gradual docking after debridement. The results calculated for eight patients (without graft infection 72.7%) are as follows: Average ROM of knee 0 to 29.3degrees, external fixator duration was 48.1 weeks, union time was 27.5 weeks, VAS score was 1.9, immediate post-operative and 6 months frame removal EQ5D5L scores were 13.8 and 10.6, respectively. ASAMI bone score was excellent in five (62.5%), good in two (25%), and fair in one (12.5%). ASAMI functional score was excellent in one (12.5%), good in six (75%), and fair in one (12.5%).

Conclusion: Masquelet method with stabilization using Ilizarov ring fixator with or without lengthening can give promising results in patients with less infection severity score. Patients with high score should be managed by only fixators (ring/monolateral).

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-024-01279-0.

查看原文本刊更多论文

Masquelet法和Ilizarov环固定器治疗股骨远端感染不连的疗效。

背景：股骨远端感染不愈合的处理非常具有挑战性，特别是当出现较晚和多次干预后。文献中描述和研究了多种方法治疗股骨感染不愈合，包括用固定物（环形固定物/单侧框架）和Masquelet方法进行骨运输。目的：探讨Masquelet法联合Ilizarov环固定器治疗股骨远端感染不愈合患者的临床和影像学结果，以及患者报告预后（EQ5D5L）和视觉模拟评分（VAS）对患者生活质量的影响。患者和方法：11例年龄在18岁至60岁之间，男女皆可，表现为股骨远端感染不愈合。平均结果为：出现时间-伤后56周，既往手术次数-2.1次，清创后骨质流失-8.5 cm，术前VAS评分-8.4，术前EQ5D5L评分-21.4,ISS-55.6, NUSS-56.54。手术分两个阶段进行。第一阶段包括清创、应用跨膝环固定器、负载万古霉素的聚甲基丙烯酸甲酯水泥垫片和闭合，一些患者在这一阶段或第二阶段进行皮质切除术。结果：3例（27.3%）患者出现移植物感染，清创后逐渐对接。8例患者（无移植物感染72.7%）的计算结果如下：膝关节平均ROM 0 ~ 29.3度，外固定架持续时间48.1周，愈合时间27.5周，VAS评分1.9，术后即刻和6个月拆架EQ5D5L评分分别为13.8和10.6。ASAMI骨评分优5例（62.5%），良2例（25%），一般1例（12.5%）。ASAMI功能评分为优1例（12.5%），良6例（75%），一般1例（12.5%）。结论：Masquelet法加Ilizarov环固定器加或不加延长的稳定对感染严重程度评分较低的患者有良好的效果。评分高的患者应仅使用固定架（环形/单侧）。补充资料：在线版本提供补充资料，网址为10.1007/s43465-024-01279-0。

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来源期刊

Indian Journal of Orthopaedics ORTHOPEDICS-

CiteScore

1.80

自引率

0.00%

发文量

185

审稿时长

9 months

期刊介绍： IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.