Outcomes of Masquelet technique combined with gentamicin-cement-coated rigid nails in the treatment of infected bone defects: A retrospective review

Abstract

Background

This study aimed to describe the bone healing, infection recurrence, and failure rates in patients with infected bone defects (IBD) of the femur and tibia in whom we combined the Masquelet technique with gentamicin-cement-coated rigid nails from the first stage.

Methods

We conducted a retrospective review of fourteen consecutive patients with IBD treated between June 2015 and December 2022 with the Masquelet technique and a gentamicin cement-coated rigid nail. Eleven patients were male; the median age was 40.5 years. Six defects were located in the femur and eight in the tibia. We analyzed the bone healing, infection recurrence, and failure rates (nonunions, graft resorption, amputations). We used the Lower Extremity Functional Scale (LEFS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess the functional outcomes.

Results

One patient needed additional debridement after the first stage. The mean time between stages was 10.28 (range 6–28) weeks. The mean LEFS score before the second stage was 62.57 ± 5.66 points. The median defect length was 6.8 cm (range 3.5–12). All the patients achieved bone healing within a median of eight months. No infection recurrences or failures were recorded. At the study closure, the mean LEFS and WOMAC were 62.07 ± 4.17, and 77.92 ± 10.89, respectively. The median follow-up was 31.71 months (range 12–80).

Conclusion

The combination of gentamicin cement-coated rigid nails with Masquelet's technique was associated with excellent bone healing and infection control in the treatment of infected bone defects in this small series. Further research is needed to validate the effectiveness of this method.