Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎疗效对比研究

目的 研究比较Masquelet技术与Ilizarov技术治疗成人胫骨慢性骨髓炎清创后大段骨缺损的早期临床疗效。方法 回顾性分析2011年1月~2015年5月我院收治的成人胫骨慢性骨髓炎病例45例,其中采用Masquelet技术治疗27例,骨缺损长度为5~15.5cm,平均8.9±2.1cm;采用Llizarov技术治疗18例,骨缺损长度为5~14.9cm,平均8.3±2.3cm。Masquelet组分2阶段治疗：第1阶段术中彻底清除感染病灶,制备个体化抗感染占位器(抗生素与PMMA骨水泥混合)植入缺损部位;第2阶段采用Masquelet技术修复骨缺损并选择合适的固定方式固定。Llizarov组11例近中段缺损采用胫骨远端截骨向近端骨搬运修复,7例中远段缺损采用胫骨近端截骨向远端骨搬运修复。记录两组病例骨愈合时间、完全负重时间,采用胫骨骨折疗效Iowa评分及中文版SF-36量表评定两组手术疗效并进行比较分析。结果 45例患者获随访,时间12~38个月,平均(21.5±6.5)个月。Masquelet组与Llizarov组骨愈合时间分别为20.8±6.0周和28.8±9.6周,完全负重时间分别为23.2±7.6周和32.8±8.4周,两组间比较差异有统计学意义(P＜0.05);两组末次随访时胫骨骨折疗效Iowa评分及SF-36量表总得分均较术前改善,差异有统计学意义(P＜0.05),两组间相同时间点指标比较无显著性差异(P＞0.05)。结论 Masquelet技术与Ilizarov技术均可以有效解决成人胫骨慢性骨髓炎清创后大段骨缺损问题,但Masquelet技术能显著缩短治疗周期,完全负重时间早,手术操作简单,患肢功能恢复良好,是治疗成人胫骨慢性骨髓炎理想的手术方法。     

Masquelet与Ilizarov技术修复感染性胫骨骨缺损比较

[目的]比较Masquelet技术与Ilizarov技术治疗胫骨感染性骨缺损的临床效果。[方法]回顾性分析2017年8月—2020年8月，本院治疗的胫骨感染性骨缺损60例患者的临床资料。依据术前医患沟通结果，35例采用Masquelet诱导膜技术，25例采用Ilizarov骨搬运技术。比较两组围手术期、随访及影像结果。[结果]两组均顺利完成手术，Masquelet组中透视总次数、手术切口愈合等级均显著优于Ilizarov组（P<0.05）。早期并发症方面，Masquelet为3/35 (8.57%)，而Ilizarov组为9/25 (36.00%)，两组差异有统计学意义（P<0.05）。两组平均随访时间（24.54±5.86）个月。Masquelet组恢复下地行走时间及完全负重活动时间显著早于Ilizarov组（P<0.05）。术后随时间推移，两组患者VAS评分均显著减少（P<0.05），而Iowa膝关节评分、Iowa踝关节评分、SF-36得分均显著增加（P<0.05）。术后6个月和末次随访时，Masquelet组的VAS评分显著优于Ilizarov组（P<0.05）；相应时间点，两组Iowa膝关节评分、Iowa踝关节评分、SF-36得分差异均无统计学意义（P>0.05）。影像方面，Masquelet组骨缺损影像愈合时间显著早于Ilizarov组（P<0.05）。[结论] Masquelet技术与Ilizarov技术均可有效治疗胫骨感染性骨缺损，但本研究中Masquelet技术的临床效果优于Ilizarov技术。     

Masquelet技术在创伤后骨髓炎中的疗效观察

目的探讨Masquelet技术在创伤后骨髓炎中应用的疗效。方法采用Masquelet技术治疗15例创伤后骨髓炎患者,术后记录并发症、完全负重时间及骨缺损愈合情况。结果患者均获得随访,时间5～18个月。无取髂骨处并发症,无内(外)固定失效,无术后再发骨折。1例第1阶段术后3周感染复发,再次行第1阶段手术后感染得到控制。完全负重时间为14～32周。末次随访时根据Paley标准评定骨缺损愈合情况:优9例,良6例。结论 Masquelet技术可以有效治疗创伤后骨髓炎,操作简便,并发症少,疗效满意。     

改良Masquelet技术联合Ilizarov Mini-Fixator治疗掌指骨大段骨缺损的临床疗效

目的 探讨改良Masquelet技术联合Ilizarov Mini-Fixator外固定治疗掌指骨大段骨缺损的可行性、临床应用及疗效分析。方法 回顾性分析2019年11月-2021年10月符合手术适应证的掌指骨大段骨缺损17例患者的病历资料,均行改良Masquelet技术联合Ilizarov Mini-Fixator外固定治疗。⑴创伤性骨缺损：一期急诊行“地毯式”清创及相应修复手术,抗生素聚甲基丙烯酸甲酯（Polymethylmethacyrlate,PMMA）填充骨缺损,皮肤软组织缺损者同时给予骨水泥覆盖;二期：行带蒂皮瓣或植皮修复皮肤缺损创面,伤口愈合6～8周后去除骨水泥行自体骨移植联合Ilizarov Mini-Fixator外固定治疗;⑵感染性骨缺损：一期彻底清创、PMMA填充骨缺损,皮肤软组织缺损或皮肤软组织条件较差者给予彻底清创修复创面;二期方案同创伤性骨缺损。术后均给予预防或控制感染、观察患指（肢）及皮瓣血运等对症处理,均早期（2周）进行功能康复训练。结果 17例术后随访5～29个月,移植骨均愈合,平均愈合时间11.9周（10.5～14.0周）,术后均未出现伤口感染及皮瓣...     

Ilizarov骨搬运与游离腓骨段移植治疗大段胫骨骨缺损的比较

目的比较Ilizarov骨搬运技术与游离腓骨段移植技术治疗大段胫骨骨缺损的临床疗效。方法回顾性分析自2010-02—2015-07诊治的28例大段胫骨骨缺损,其中采用Ilizarov骨搬运技术治疗15例(骨搬运组),采用游离腓骨段移植技术治疗13例(腓骨移植组)。比较2组外固定时间、外固定指数、术后完全负重时间、完全负重指数及末次随访时Puno功能评分。结果 28例均获得随访,随访时间平均32(23~41)个月。骨搬运组外固定时间长于腓骨移植组,差异有统计学意义(P0.05);但2组外固定指数、术后完全负重时间、完全负重指数及末次随访时Puno功能评分差异无统计学意义(P0.05)。骨缺损长度11 cm时,骨搬运组Puno功能评分高于腓骨移植组,差异有统计学意义(P0.05);骨缺损长度≥11 cm时,腓骨移植组在外固定时间、外固定指数、术后完全负重时间方面优于骨搬运组,差异有统计学意义(P0.05)。结论 Ilizarov骨搬运技术和游离腓骨段移植技术都是大段胫骨缺损行之有效的治疗方法 ,骨缺损长度11 cm时可优先采用Ilizarov骨搬运技术,骨缺损长度≥11 cm时可由技术水平较高的医师采用游离腓骨段移植技术。     

Masquelet技术联合富血小板血浆修复胫骨大段骨缺损

目的探讨Masquelet技术联合富血小板血浆(PRP)修复胫骨大段骨缺损的疗效。方法采用前瞻性随机对照单盲方法选取佛山市中医院修复重建外科2016年6月至2018年6月收治的21例胫骨大段骨缺损患者,骨缺损长度为6.0~22.5 cm(平均10.8 cm)。男14例,女7例;年龄29~60岁,平均42.1岁。采用随机数字表加密封信法,单数为试验组,双数为对照组:试验组11例,采用Masquelet技术联合PRP进行骨缺损重建;对照组10例,采用Masquelet技术进行骨缺损重建。比较两组患者第二阶段的手术时间、住院时间及伤口愈合情况以及第二阶段术后两组患者的负重时间、骨性愈合时间、临床愈合时间、并发症的发生情况及Johner-Wruhs评分。结果试验组与对照组患者术前一般资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后获12~24个月(平均14.9个月)随访。两组患者第二阶段的手术时间、住院时间、伤口愈合情况、负重时间、Johner-Wruhs评分、并发症发生率比较,差异均无统计学意义(P>0.05)。试验组的骨性愈合时间、临床愈合时间分别为(4.5±1.2)、(4.1±0.9)个月,均短于对照组的(5.7±1.5)、(5.4±1.1)个月,差异有统计学意义(P<0.05)。试验组患者未发现明显术后感染、内固定物松动、骨吸收、骨不连等并发症;对照组出现1例伤口感染患者,予换药后好转。结论Masquelet技术联合PRP可有效修复胫骨大段骨缺损,提高骨愈合速度,是一种安全、有效的治疗方法。     

Ilizarov骨搬移技术修复胫骨创伤性骨髓炎大段骨缺损

目的探讨应用Ilizarov骨搬移技术治疗胫骨创伤性骨髓炎大段骨缺损的临床疗效。方法回顾性分析2010年6月至2014年9月在我科收治15例胫骨创伤性骨髓炎患者,其中男11例,女4例;年龄17~60岁,平均39.3岁。交通事故伤9例,重物压砸伤4例,高处坠落伤2例。根据Cierny-Mader解剖学分型:Ⅲ型6例,Ⅳ型9例。采用病灶骨段切除、Ilizarov骨搬移技术治疗,并记录骨段延长长度、外固定架时间、骨愈合及功能评价结果。结果 15例患者均获随访,随访时间18~40个月,末次随访时,骨缺损均得以重建。骨缺损长度6~13 cm,平均8.6 cm。外固定架固定时间为8.4~16.5个月,平均11.2个月。术后无一例出现深部感染、骨不连或关节僵直。根据改良ASAMI评定标准评定骨性结果:优12例,良1例,中1例,差1例,优良率为87.3%;功能结果:优10例,良2例,中3例,差0例,优良率为80.0%。结论应用Ilizarov骨搬移技术是治疗胫骨创伤性骨髓炎大段骨缺损的有效方法。     

膜诱导技术治疗成人长骨慢性骨髓炎早期临床疗效

目的:探讨膜诱导技术治疗成人长骨慢性骨髓炎清创后大段骨缺损的早期临床疗效。方法:2010年3月至2012年3月共收治成人长骨慢性骨髓炎23例,男15例,女8例;年龄26~49岁,平均35.2岁;16例初始损伤为开放性骨折,6例为闭合性骨折,1例无骨折病史。胫骨12例,股骨7例,肱骨3例,尺桡双骨1例;骨干19例,干骺端4例。病程4~13个月,平均6.9个月。所有患者采用膜诱导技术分2个阶段治疗,记录患肢术后并发症、骨愈合时间及功能情况,并采用中文版SF-36量表评定手术疗效。结果:所有患者获随访,时间18~43个月,平均(27.6±5.3)个月。术后2例出现皮瓣边缘部分坏死,1例髂骨切口浅表感染,余无明显围手术期并发症发生。20例获得Ⅰ期骨愈合,平均愈合时间4.6个月(3~7个月),其中16例下肢手术患者完全负重时间5.2个月(4~8个月);3例随访期间出现感染,再次接受膜诱导手术后达到完全骨愈合。末次随访时SF-36量表各维度得分及总分较术前改善。结论:膜诱导技术可以有效解决成人长骨慢性骨髓炎清创后大段骨缺损问题,显著缩短治疗周期,手术操作简单,术后并发症少,患肢功能恢复良好,早期疗效满意。     

应用Ilizarov技术修复胫骨慢性骨髓炎并骨缺损

目的探讨应用Ilizarov技术治疗胫骨创伤后慢性骨髓炎并感染性骨缺损的临床疗效。方法对8例胫骨创伤后慢性骨髓炎并感染性骨缺损行清创、可延长外固定架固定、干骺端截骨及中间骨段逐步搬运。结果 8例均获随访6～40个月,平均31.5个月。骨与皮肤缺损得到修复,患侧肢体长度与健侧无明显短缩。结论应用Ilizarov技术治疗难治性胫骨骨髓炎合并骨缺损或皮肤软组织缺损创伤小,能够避免多次复杂手术,可简化治疗过程,疗效肯定。     

Masquelet技术治疗胫骨慢性骨髓炎

目的探讨Masquelet技术治疗胫骨慢性骨髓炎的效果。方法采用Masquelet技术治疗15例胫骨慢性骨髓炎患者,手术分两期进行,一期彻底清创,植入抗生素骨水泥,9例皮肤缺损患者选择合适皮瓣覆盖创面;二期感染控制后取自体骨或者自体骨混合异体骨植骨。结果 15例均获得随访,时间12~24个月。骨髓炎均得到控制,骨折均愈合,无复发。末次随访根据Paley标准评定骨缺损愈合分级:优12例,良3例。邻近关节功能恢复:优7例,良6例,可2例。结论 Masquelet技术具有疗效可靠、操作简单、并发症少、对受区要求低、易推广等优势,是治疗胫骨慢性骨髓炎的一种有效方法。     

Comparison of internal and external fixation after debridement in the Masquelet technique for Cierny-Mader type IV tibial post-traumatic osteomyelitis

ObjectiveTo compare the effect of internal fixation vs. external fixation after debridement in stage I of the Masquelet technique for Cierny-Mader (C-M) type Ⅳ chronic post-traumatic tibial osteomyelitis.MethodsThis retrospective observational study included patients with tibial osteomyelitis who underwent staged treatment with the Masquelet technique between January 2016 and June 2020 at the 920 Hospital of Joint Logistic Support Force of the PLA. The patients were grouped according to the fixation they received after stage I. Infection recurrence, time to radiological bone healing and full weight-bearing, self-rating anxiety scale (SAS) score, Hospital for Special Surgery (HSS) Knee Score, and American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were compared.ResultsSixty-three patients were included (50 males and 13 females). There were 40 and 23 patients with internal and external fixation, respectively. There were no significant differences between the two groups regarding the preoperative and intraoperative data (all P>0.05). After stage I operation, the infection control rates were 85.0% and 82.6% in the internal and external fixation groups (P=0.803), and these rates were 92.5% and 95.7% after stage II (P=0.621). There were no differences in the SAS scores (P=0.278), time to radiological union (P=0.795), time to full weight-bearing (P=0.725), AOFAS scores (P=0.302), HSS scores (P=0.085), and complication rates (P=0.593). There were 27 times complications in 19 patients, with an incidence of 42.9%, without significant differences between groups.ConclusionThere were no differences between the two fixation methods after debridement in stage I of the Masquelet technique for C-M type Ⅳ chronic post-traumatic tibia osteomyelitis.     

多种技术联用治疗难治性骨髓炎的疗效分析

目的探讨应用Ilizarov骨搬移技术联合抗生素骨水泥片技术、Masquelet技术(膜诱导技术)等技术治疗长骨慢性骨髓炎的临床疗效。 方法回顾性分析2012年6月至2016年10月,新疆军区总医院创伤骨科联合应用病灶清除、Ilizarov技术、抗生素骨水泥片填充技术、膜诱导成骨技术、远端缓慢回缩技术等技术治疗的20例股骨、胫骨慢性骨髓炎和感染性骨不连患者。纳入标准：慢性骨髓炎合并骨不连或骨缺损的患者;经常规治疗效果差的患者;无影响治疗的合并症;病例资料完整的患者。排除标准：不符合疾病的纳入标准;存在活动性结核、肿瘤等疾病的患者;依从性差、不能按照医生要求调整外固定架的患者。记录上述患者是否需行皮瓣转移手术、带外固定架时间、全负重时间及是否出现复发情况。 结果所有患者均得到随访,随访时间平均(29.2±1.8)个月。均获得了良好的骨性愈合,所治疗患者感染均得到一期愈合,创面无需皮瓣转移或植皮均得到良好闭合,骨搬移结合处愈合良好。患者骨搬移长度平均(7.3±1.8)cm。所有患者未出现神经损伤,其中有两例患者术前存在腓总神经损伤,术后在骨搬移过程中出现不同程度的神经功能恢复。 结论应用Ilizarov的骨搬移和骨延长技术能有效治疗彻底清创后的骨缺损或肢体短缩问题,保证彻底清创、促进局部血运改善、不需要皮瓣覆盖也能愈合创面;抗生素骨水泥片起到占位器和膜诱导作用促进成骨;远端缓慢回缩有利于骨端愈合;多种方法联合应用,有效地提高了难治性骨髓炎的治愈率,是一种安全有效的治疗方法。     

Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis

ObjectiveThis study was to compare the effectiveness of Masquelet technique versus Ilizarov bone transport in the treatment of lower extremity bone defects following posttraumatic osteomyelitis.Patients and methodsWe retrospectively reviewed 39 patients who had been treated at our department for lower extremity bone defects following posttraumatic osteomyelitis. They were 30 males and 9 females with a mean age of 39.18 (range, 12–63 years). The infected bone defects involved 26 tibias and 13 femurs. The mean length of the bone defects after radical debridement was 6.76 cm (range, 2.7–15.7 cm). Masquelet technique (MT, group A) was used in 20 patients and Ilizarov bone transport (IBT, group B) in 19 ones. The measurements were bone outcomes (union, deformity, infection and leg-length discrepancy) and functional outcomes (significant limping, joint contracture, soft tissue dystrophy, pain and inactivity).ResultsThe mean follow-up after removal of the apparatus was 25.26 months (range, 14–51 months). The mean finite fixator time was 10.15 months (range, 8–14 months) in group A versus 17.21 months (range, 11–24 months) in group B. The bone outcomes were similar between groups A and B [excellent (5 vs. 7), good (10 vs.9), fair (4 vs. 2) and poor (1 vs. 1)]; group A showed better functional outcomes than group B [excellent (8 vs. 3), good (9 vs. 6), fair (3 vs. 8) and poor (0 vs. 2)].ConclusionsIn the treatment of segmental lower extremity bone defects following posttraumatic osteomyelitis, both IBT and MT can lead to satisfactory bone results while MT had better functional results, especially in femoral cases. IBT should be preferred in cases of limb deformity and MT may be a better choice in cases of periarticular bone defects.     

病灶清除联合Ilizarov技术治疗第一跖趾关节痛风石合并骨缺损

目的探讨病灶清除联合Ilizarov技术治疗第1跖趾关节痛风石合并骨缺损疗效。方法2016年7月—2018年6月,采用病灶清除联合Ilizarov技术治疗14例第1跖趾关节痛风石合并骨缺损患者。男12例,女2例;年龄22~60岁,平均39.3岁。病程5~15年,平均11.2年。痛风石体积2.5 cm×2.7 cm×2.2 cm^5.2 cm×2.9 cm×2.4 cm。X线片显示骨缺损长度2.0~4.6 cm,平均3.4 cm。术前疼痛视觉模拟评分(VAS)为(7.6±0.9)分,美国矫形外科足踝协会(AOFAS)评分为(47.5±4.3)分,简明健康调查量表(SF-36量表)评分为(79.7±4.7)分。结果术后13例切口Ⅰ期愈合;1例切口边缘皮肤坏死,对症处理后愈合。14例患者均获随访,随访时间12~16个月,平均13.6个月。X线片示第1跖列骨缺损修复;骨延长时间2~6周,平均3.6周;截骨愈合时间9~16周,平均11.2周。随访期间未出现神经、血管、肌腱损伤等并发症,无针道感染,后期无应力性骨折发生。末次随访时,VAS评分为(1.4±0.5)分、AOFAS评分为(86.6±4.8)分、SF-36量表评分为(89.1±3.3)分,均优于术前,差异有统计学意义(t=22.532,P=0.000;t=22.702,P=0.000;t=6.124,P=0.000)。结论病灶清除联合Ilizarov技术是一种安全、有效的治疗第1跖趾关节痛风石合并骨缺损的方法。     

Early resection of congenital pseudarthrosis of the tibia and successful reconstruction using the Masquelet technique

Congenital pseudarthrosis of the tibia remains one of the most difficult orthopaedic problems. We describe early excision and the use of the Masquelet technique to reconstruct the bone defect in a child aged 14 months. Consolidation sufficient for complete weight-bearing was achieved by seven weeks. After two and a half years, the child was asymptomatic with a fully reconstructed tibia and no leg-length discrepancy.     

NRD辅助Ilizarov技术治疗胫骨感染性骨与软组织缺损

目的:探讨NRD辅助Ilizarov技术治疗胫骨感染性骨与软组织缺损的临床疗效。方法:选取2013年3月至2020年12月治疗的胫骨感染性骨与软组织缺损患者48例,男34例,女14例,年龄24~55(40.54±11.64)岁,分为研究组与对照组。研究组患者25例,男17例,女8例,年龄31~55(41.36±9.69)岁,采用NRD辅助Ilizarov骨搬移技术治疗。对照组23例患者,男17例,女6例,年龄24~53(38.61±8.76)岁,采用传统骨搬移技术治疗。通过两组患者的治愈率、复发率、针道感染发生率、抗生素使用时间、创面愈合时间、外固定携带时间、骨搬移时间、骨愈合情况、术后功能等指标评价治疗效果。结果:随访时间12~62(33.0±7.2)个月,末次随访时,两组患者的治愈率比较,差异无统计学意义(P>0.05),研究组复发率低于对照组(P<0.05),针道感染发生率低于对照组(P<0.05)。研究组的抗生素使用时间、创面愈合时间均少于对照组(P<0.05),两组之间的骨搬移时间、外固定携带时间差异无统计学意义(P>0.05),两组骨愈合情况、术后功能差异无统计学意义(P>0.05)。结论:NRD辅助Ilizarov技术治疗胫骨感染性骨与软组织缺损,可以达到满意的治疗效果,缩短了治疗周期及抗生素使用时间。     

Die Masquelet-Technik zur Behandlung großer dia- und metaphysärer Knochendefekte

Objective

Treatment of large dia- and metaphyseal bone defects (>?3 cm) with two surgical interventions with an interval of 4–8 weeks.

Indications

Dia- and metaphyseal bone defects predominantly of the lower extremity.

Contraindications

Intraarticular bone defects, persisting bone infection or osteomyelitis, insufficient soft tissue coverage in the region of the bone defect, osteoporosis.

Surgical technique

First surgical intervention: thorough bone debridement and soft tissue coverage, implantation of a cement spacer into the bone defect for the induction of a synovial foreign-body membrane, internal or external fixation. Second surgical intervention: removal of the cement spacer and filling of the bone defect with autologous cancellous bone graft, optionally internal fixation after initial external fixation.

Postoperative management

Partial to full weight-bearing after the first surgical intervention depending on pain. Partial weight-bearing (max. 15 kg) after the second surgical intervention, until radiological signs of a remodeling of the regenerate bone occur. Usually no implant removal.

Results

A total of 6 patients (4 men, 2 women) aged 15–66 years with average bone defects of 7 cm (range 4–10 cm) were treated using the Masquelet technique. There were 2 aseptic femoral nonunions and 4 tibial nonunions (2 septic and 2 aseptic nonunions). One case was a periprosthetic tibial bone defect. Bone stabilization after debridement was performed using ring fixators on the tibia and an intramedullary nail and a locking plate on the femur, respectively. The second surgical intervention was performed after 6–9 weeks. In 3 of the 4 tibial cases, internal fixation was performed during this intervention. The iliac crest and the RIA (reamer–irrigator–aspirator) technique were used for cancellous bone grafting. Amputation after breakage of the plate was necessary in the patient with the periprosthetic bone defect. Nonunion at the docking site required cancellous bone grafting in 1 patient. All 5 patients were able to perform full weight-bearing without pain after 6 months. The Ilizarov fixator was removed 5 months after the second surgical intervention in a 15-year-old patient. None of the other implants were removed.

     

Management of childhood chronic tibial osteomyelitis with the Ilizarov method

The efficacy of the Ilizarov method in the management of the long bone defect is well established. There have been rare reports about the use of the Ilizarov method in the bone defect caused from childhood osteomyelitis. In this article, the authors present results of seven patients with childhood chronic hematogenous osteomyelitis of the tibia who were treated with the Ilizarov method. The treatment protocol also included sequestrectomy and debridement, appropriate antibiotic therapy, and bifocal treatment with the Ilizarov method. The mean age was 7.2 years old (range 6-8). After sequestrectomy and debridement, all cases were classified as B1 infected pseudoarthrosis according to Paley's criteria. All patients had active infection at the beginning of the treatment. The mean bone defect was 7.4 cm (range 3.5-12). Follow-up time was 4.6 years (range 2.7-5.8). At the time of fixator extraction, complete consolidation was obtained in all the patients. Healing index was 32.3 days/cm (range 28-44). Bone grafting was not required at the docking site in any of the patients. Functional and radiologic results were judged excellent according to Paley's criteria in all patients at the last follow-up. This study indicates that the bifocal method of the Ilizarov treatment is the best alternative for the bone defect caused by chronic hematogenous osteomyelitis in children.     

Masquelet technique with external locking plate for recalcitrant distal tibial nonunion

ObjectiveIn the present retrospective study, we aimed to analyze the results of treatment for recalcitrant distal tibial nonunion using Masquelet technique with locking plate as a definitive external fixator.MaterialsWe included 15 consecutive cases of distal tibial nonunion treated at our hospital between January 2012 and December 2015. The reconstructive procedure comprised debridement of the nonunion site, deformity correction, stabilization with an external locked plate, defect filling with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique). All patients were followed-up for at least one year.ResultsFracture union occurred in all cases after a median of 6.5 months (range, 5–12 months). Mean ankle motion ranged from 12.3 (range, 5–20) degrees of dorsiflexion to 35 (range, 5–55) degrees of plantar flexion. At the final follow-up, the median Iowa ankle score was 83 (range, 68–91). Eight patients had excellent scores, six had good scores, and one had fail score.ConclusionAlthough the current study involved only a small number of patients and the intervention comprised two stages, we consider that the used protocol is a simple and valuable alternative for the treatment of recalcitrant distal tibial nonunion.     

Modified Masquelet technique in children

Masquelet technique is one of the modalities for the treatment of long bone defect. Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and open growth plate. We reported a case of 13-year-old male who presented with gap non-union of middle third of tibia. We applied a modified Masquelet technique by using only the cortical fibular graft instead of cancellous bone to fill the space surrounded by induced membrane. Fibula was used as a nonvascularized strut graft and matched stick graft to achieve complete union. We concluded that nonvascularized fibula grafting is an easy and effective option to fill the bone defect in children in the second stage of Masquelet technique.