Methicillin– resistant Staphylococcus aureus (MRSA) infected gap non –union of long bones fractures is a challenge to manage. Treatment options are limited such a Ilizarov bone transport, vascularized bone free transfer etc. These techniques have complications and require expertise. We present a rare case with MRSA infected nonunion and bone defect 5cm of ulna which was managed with the induced membrane formation.

A 33-years old male presented to outpatient department, 2 months after internal fixation on both left bone forearm fractures (Gustillo I). There was pus discharge from the operative site of ulna. Culture results: MRSA, C-Reactive Protein (CRP): 2,58 (0–5), Erythrocyte Sedimentation Rate (ESR): 42 (0–20). Intravenous (iv) Teicoplanin and Rifampicin were administrated and after one month no topic symptoms and CRP- ESR were normal. One month later he had again actively draining sinus (CRP: 1,47 ESR:22). The implant (ulna) was removed and a gap 5 cm was created at the fracture site (necrotic-infected bone debrided), which was filled by cemented spacer (Tobramycin and vancomycin). An external fixator was applied to ulna. Radius was not involved. Post op. iv the same antibiotics for 4 weeks. At the end of 8 weeks, the spacer was removed and the gap was filled with autologous cancellous bone graft (iliac crest).

After 5 months the patient was reviewed. No any clinical and functional problems. Radiographics and CT-images were showed osseous consolidation.

This technique (called as ‘Masquelet’) gives promising result in the management of infected long bone defects in upper extremity.

The use of hybrid þxation (cementless acetabular component and cemented femoral component) in primary total hip arthroplasty has been based on several observations: 1. The long-term problems associated with cemented acetabular þxation 2. The durable long-term results reported with cemented femoral þxation and 3. The encouraging reports of different centers on using the above technique. Methods: Between 1992 and 1997, 194 primary hybrid total hip arthroplasties were performed in our department in 171 patients. Follow up was performed at 5 to 10 years after the procedure. The average age at the time of the procedure was 69 years (range, 44 Ð 82 years). There were 102 women (123 hips) and 69 men (71 hips). 2 different groups of arthroplasties were used; one consisting of a microporous coated cup and one consisting of a hydroxyapatite-layered cup. The patients were prospectively observed clinically using the Harris Hip Score and radiographically. Results: The Harris Hip Score was preoperatively 43 in average (range, 15–55) and postoperatively increased to 88 points (range, 61–100). Five arthroplasties were revised; 1 due to acetabular loosening, 3 due to femoral loosening and 1 due to aseptic loosening. No cup migration of more than 1 mm could be observed. There were no radiolucencies around any of the screws used for the þxation of the cup. Conclusions: The clinical results of the hybrid total hip arthroplasties show excellent intermediate period results in respect of clinical performance and þxation durability.