The
The
In a consecutive retrospective analysis of 190 patients treated with the
Recent researches indicate that both M1 and M2 macrophages play vital roles in tissue repair and foreign body reaction processes. In this study, we investigated the dynamics of M1 macrophages in the induced membrane using a mouse femur critical-sized bone defect model. The
Aim. infected segmental bone defect (ISBD) is frequent in developing countries. The aim of this study was to assess the efficacy of the
Aims. The purpose of this study was to: review the efficacy of the induced membrane technique (IMT), also known as the
Aim. Which patients is bone-defect-reconstruction with the Masquelet-technique suitable and which problems did we see?. Method. From 11/2011 to 4/2016 we treated 49 Patients (12f/37m) with bone-defects up to 150mm after septic complications with the Masquelet-technique. We had infected-non-unions of upper and lower extremity, chronic osteomyelitis, infected knee-arthrodesis and upper-ancle-empyema. On average the patients were 48 (8–74) years old. The mean bone-defect-size was 60 mm (25–150). From other hospitals came 47 of the 49 patient, where they had up to 20 (mean 4,9) operations caused by the infection. The time before transfer to our hospital was on average 177days (6–720). 40 patients receaved flaps because of soft tissue-defects (12 free flaps, 28 local flaps). 21 patients suffered a polytrauma. In 8 cases the femur, in 4 cases a knee-arthrodesis, in 34 cases tibia, in 2 cases humerus and in 1 case the ulna were infected resulting in bone defects. Indication for the Masquelet-technique was low-/incompliance in 35 cases due to higher grade of traumatic brain injury and polytrauma and difficult soft-tissue conditions, in 9 times problems with segment-transport and in 5 cases as dead space management. Positive microbial detection succeeded in 32 patients at the first operation. Mainly we found difficult to treat bacteria. After treating the infection with radical sequestrectomy, removal of foreign bodies and filling the defect with antibiotic loaded cement spacer and external fixation we removed the spacer6–8 weeks later and filled the defect with bone graft. In 23 cases we stabilized the defect then with an internal angle stable plate. All patients were examined clinically and radiologically every 4–6 weeks in our outpatient-department until full weight bearing, later every 3 months. Results. In 41 of 49 cases the infection was clinically treated successfully. 21 patients are allowed for full weight bearing (all with secondary internal plates). There were 8 recurrences of infection, 22 instabilities needing internal stabilization and further bone graft. We saw “Plate-breaks” in 4 cases. 2 patients underwent amputation. Conclusions. For patients with low-/incompliance for various reasons and for those with difficult soft tissue conditions following flaps the
Congenital pseudarthrosis of the tibia remains one of the most difficult orthopaedic problems. We describe early excision and the use of the
The clinical case refers to a male patient, 34 years old, admitted at the Emergency Department after a fall of 2 meters. Of that trauma, resulted an exposed Monteggia fracture type III – Gustillo & Anderson IIA – on his left arm. With this work, the authors intend to describe the evolution of the patient's clinical condition, as well as the surgical procedures he was submitted to. The authors used the patient's records from Hospital's archives, namely from the Emergency Department, Operating Room, Infirmary and Consultation, and also the diagnostic exams performed throughout the patient's clinical evolution. The clinical case began in December 2011, when the patient suffered a fall of 2 meters in his workplace. From the evaluation in the Emergency Department, it was concluded that the patient presented, at the left forearm, an exposed Monteggia type III fracture – Gustillo & Anderson IIA – combined with a comminuted fracture of the radial head. At the admission day, the wound site was thoroughly rinsed, the fracture was reduced and immobilized with an above-the-elbow cast, and antibiotics were initiated. Six days after admission, the patient was submitted to open reduction with internal fixation with plate and screws of the fracture of the ulna and radial head arthroplasty. The postoperative period was uneventful. Two months after the surgical procedure, inflammatory signals appeared with purulent secretion in the ulnar suture. Accordingly, the patient was submitted to fistulectomy, rinsing of the surgical site and a cycle of antibiotics with Vancomycin, directed to the S. aureus isolated from the purulent secretion. The clinical evolution was unfavorable, leading to the appearance of a metaphyseal pseudarthrosis or the ulna and dislocation of the radial head prosthesis. The previously implanted material was therefore removed, 4 months after the traumatic event; at the same time an external fixation device was applied and the first part of a
For which patients is bone-defect-reconstruction with the Masquelet-technique suitable?. Between 11/2011 and 1/2015 we treated 27 Patients (4 female/ 23 male) with bone-defects up to 150mm after septic complications with the Masquelet-technique. Reason of the bone defects were infected-non-unions of lower extremity, chronic osteomyelitis, infected knee-arthrodesis, chronic upper-ancle-empyema and infect-defect-non-union of the humerus. On average the patients were 47,5 (18–74) years old. The mean bone-defect-size was 62,6 mm (25–150). 26 of the 27 patients came from other hospitals, where they had up to 20 (mean 4,9) operations caused by the infection. The time before transfer to our hospital was on average 177days (6–720). 25 patients receaved flaps because of soft tissue-defects (7 free flaps, 18 local flaps). 13 patients suffered a polytrauma. In 5 cases the femur, in 3 cases a knee-arthrodesis, in 18 cases the tibia and in 1 case the humerus was affected by infection resulting in bone defects. Indication for the Masquelet-technique was low-/incompliance in 10 cases due to higher grade of traumatic brain injury and polytrauma and difficult soft-tissue conditions, in 6 times after problems with segment-transport and in 1 case as dead space management. Positiv microbial detection succeeded in 19 patients at the first operation although most of the patients underwent long term antibiotic therapy. Mainly we found problematic bacteria. At the time of defect reconstruction with spongious graft we found persistant bacteria in 4 cases. The first operation aimed treating the infection with radical sequestrectomy, removal of foreign bodies and filling the defect with an antibiotic loaded cementspacer as well as external fixation. 6–8 weeks later we removed the spacer and filled the defect with autologous bonegraft. In 2 cases we needed 2 bone grafts to fill the defect. In 9 cases we removed the fixateur and stabilized the defect with an internal anglestable plate. All patients were examined clinically and radiologically every 4–6 weeks in our outpatient-department for osteitis until full weight bearing and later every 3months. In 22 of 27 cases the infection was clinically treated successfully. 5 patients are allowed for full weight bearing (all with secondary internal plates). No patient underwent amputation. There were 4 recurrences of infection, 9 instabilities needing internal stabilization and further bonegraft. For patients with low-/incompliance for various reasons and for those with difficult soft tissue conditions following flaps the
We hypothesise that the
Aim. For which patients is bone defect reconstruction with the Masquelet-technique after the treatment of osteomyelitis suitable and which results did we have. Methods. From 11/2011 to 4/2018 we treated 112 Patients (36f, 76m) with bone defects up 150mm after septic complications with the Masquelet-technique. We had infected-non-unions of upper and lower extremity, chronic osteomyelitis, infected knee-arthrodesis and knee- and ankle-joint-empyema. On average the patients were 52 (10–82) years old. The mean bone defect size was 48 mm (15–150). Most of our patients came from other hospitals, where they had up to 20 (mean 5.1) operations caused by the infection. Time before transfer in our hospital was on average 7,1 months (0,5–48). 77 patients received free (25) or local (52) flaps because of soft tissue-defects. 58 patients suffered a polytrauma. In 23 cases femur, in 4 cases a knee arthrodesis, in 68 cases tibia, in 1 case foot, 6 times ankle-joint arthrodesis, in 6 cases humerus, in 4 cases forearm were infected resulting in bone defects,. In most cases the indication for the Masquelet-technique was low-/incompliance due to higher grade of brain injury and polytrauma followed by difficult soft tissue conditions and problems with segmenttransport. In 2/3 positive microbial detection succeeded at the first operation. Mainly we found difficult to treat bacteria. After treating the infection with radical sequestrectomy, removal of foreign bodies and filling the defect with antibiotic loaded cementspacer and external fixation we removed the spacer in common 6–8 weeks later and filled the defect with autologeous bone graft. Most of the patients needed an internal fixation after removing of the fixex. All patients were examined clinically and radiologically every 4–6 weeks in our outpatient department until full weight bearing, later every 3 Months. Results. in 93 of 112 cases the infection was clinically treated successful. 48 patients are allowed full weight bearing (45 with secondary internal plates). There were 18 recurrences of infection, 3 patients underwent lower limb amputation. Conclusions. For patients with low-/incompliance for various reasons and for those with difficult soft tissue conditions following flaps the
A high volume of trauma and limited resources means that traditional methods of bone reconstruction are not feasible in parts of Africa. We present the management and outcomes of using
The
Aim. The induced membrane technique (IMT) or
This work refers to a male patient, 25 years of age, admitted in the Emergency Department following a bicycle accident, of which resulted an open fracture of the right forearm bones – Gustillo & Anderson I. With this work, the authors have as objective the description of the patient's clinical condition – starting with the fracture, over to the osteomyelitis – as well as the surgical procedures and remaining treatments he was submitted to. The authors used the patient's records from Hospital's archives, namely records from the Emergency Department, Operating Room, Infirmary and Consultation, and also the diagnostic exams performed throughout the patient's clinical evolution. This clinical case began in May 2013, when the patient suffered an open fracture of the right forearm bones – Gustillo & Anderson I – due to a bicycle accident. At the time, the exposure site was thoroughly rinsed, a cast immobilization was made, and antibiotics were prescribed. In the fifth day following the trauma, the patient was submitted to an open reduction with internal fixation with plate and screws of both forearm bones. In the following period, the distal segment of the suture suffered necrosis, exposing the radial plate and the tendons of the first dorsal compartment. The Plastic Surgery team was then contacted, proposing the execution of a graft over the exposed area, which was made in August 2013. In the postoperative period, about half the graft lost its viability and it was noted that a radial pseudoarthrosis had developed – in the context of osteomyelitis – with a defect of about 9 centimeters. This condition prompted the extraction of the osteosynthesis material, about 4 months after its application, and at the same time the first stage of a
Purpose of the study: The objective of this study was to establish an experimental sheep model for a surgical procedure which has been clinically successful for repairing major loss of bone stock: the
Previous clinical studies have shown the efficacy of a foreign body-induced membrane combined with bone autograft for the reconstruction of traumatologic or pathologic large bone defects or, bone non union. This membrane, rich in mesenchymal stromal cells (MSC), avoids bone autograft resorption and promotes consolidation by revascularisation of the bone and secretion of growth factors. Reconstruction requires two different surgical stages: firstly, insertion of a cement spacer in the defect, and secondly, removal of the spacer, preservation of the foreign body-induced membrane and filling of the cavity by bone autograft. The optimal time to perform the second surgical stage remains unclear. So, we aimed to correlate bone healing and, phenotype and function of cells isolated from the induced membrane, in patients whose second surgery was performed on average after 6 months (i.e. beyond the recommended time of one month). Cell phenotype was determined by flow cytometry and cell function by: alkaline Phosphatase enzyme activity, secretion of calcium and von Kossa staining. Second, using histological and immunohistochemistry studies, we aimed to determine the nature and function of induced membrane over time. Seven patients were included with their consent. Results showed Treated patients achieved in all cases bone union (except for one patient) and in in vitro and histology and immunohistochemistry gave some indications which need to be completed in the future. First, patient age seemed to be an indicator of bone union speed and recurrent infection, appeared to influence in vitro MSC osteogenic potential and induced membrane structure. Second, we reported, in bone repair situation, the commitment over time in osteogenic lineage of a surprising multipotent tissue (induced membrane) able of vascularisation/ osteogenesis/ chondrogenesis at a precocious time. Finally, best time to perform the second stage (one month) could be easily exceeded since bone union occurred even at very late times.
The February 2023 Trauma Roundup. 360. looks at:
Aims. Musculoskeletal infection is a devastating complication in both trauma and elective orthopaedic surgeries that can result in significant morbidity. Aim of this study was to assess the effectiveness and complications of local antibiotic impregnated dissolvable synthetic calcium sulphate beads (Stimulan Rapid Cure) in the hands of different surgeons from multiple centres in surgically managed bone and joint infections. Methods. Between January 2019 and December 2022, 106 patients with bone and joint infections were treated by five surgeons in five hospitals. Surgical debridement and calcium sulphate bead insertion was performed for local elution of antibiotics in high concentration. In all, 100 patients were available for follow-up at regular intervals. Choice of antibiotic was tailor made for each patient in consultation with microbiologist based on the organism grown on culture and the sensitivity. In majority of our cases, we used a combination of vancomycin and culture sensitive heat stable antibiotic after a thorough debridement of the site. Primary wound closure was achieved in 99 patients and a split skin graft closure was done in one patient. Mean follow-up was 20 months (12 to 30). Results. Overall, six out of 106 patients (5.6%) presented with sepsis and poorly controlled comorbid conditions, and died in the hospital within few days of index surgery. Out of the remaining 100 patients, control of infection was achieved in 95 patients (95%). Persistence of infection was noted in five (5%) patients. Out of these 95 patients that had good control of infection, four patients (4.2%) with gap nonunion needed