Masquelet technique combined with internal fixation in the treatment of infected subtrochanteric nonunion of femur by stages
XIE Yun-fei
LI Meng
LU Xiao-tian
SU Yi-tong
LUO Xiang-li
Abstract：Objective To investigate the effectiveness of Masquelet technique combined with internal fixation for patients with subtrochanteric bone nonunion.Methods The data of 8 adult patients with infected bone nonunion after internal fixation of subtrochanteric fracture treated in Gansu Provincial People's Hospital from May 2020 to May 2023 were retrospectively analyzed,including 6 males and 2 females.The age ranged from 48 to 67 years,with a mean of(52.6±4.3)years.The course of disease ranged from 8 to 76 months,with an average of(27.2±11.3)months.According to the Seinsheimer type,there were 2 cases of ⅢA type,1 case of ⅢB type,4 cases of Ⅳ type and 1 case of Ⅴ type.The original internal fixation methods included intramedullary system fixation in 6 cases and plate fixation in 2 cases.All patients were treated in a two-stage treatment with membrane induction technology.Phase Ⅰ:Removal of the original internal fixator and complete debridement,implantation of antibiotic bone cement in the defect area,and fixation with lockingcompressionplate(LCP);Phase Ⅱ:The antibiotic bone cement was removed,and the fracture end was stabilized with LCP and/or intramedullary nail and bone grafting was performed.Use the white blood cell count(WBC),procalcitonin(PCT),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)to assessed patients'infection control at stage Ⅰ and the final follow-up,and record bone healing time.Bone healing was evaluated by SamanthaX line score and Paley bone score at the last follow-up.Functional recovery of affected limb was evaluated by visual analogue scale(VAS)and Sanders score after hip injury.Results 8 patients were followed up for 12 to 32 months,with an average of(21.6±10.3)months.The infection recurred after the operation of stage Ⅰ in one case,which was effectively controlled after the second debridement.During the follow-up period,there was no recurrence,and the infection rate of stage Ⅰ was 87.5%(7/8).No incision rupture,effusion,infection recurrence,bone nonunion,or venous thrombosis occurred in 8 patients during follow-up.At the last follow-up,WBC[(6.50±1.03)×109/L vs.(12.67±0.43)×109/L],ESR[(6.25±1.08)mm/h vs.(32.31±4.66)mm/h],PCT[(0.44±0.15)ng/ml vs.(13.28±1.50)ng/ml]and CRP[(3.09±0.47)mg/L vs.(14.48±0.95)mg/L]were significantly improved compared with those before operation,and the differences were statistically significant(P<0.05).The Samantha X line score was 4 to 6 with an average of 4.9 points,and the VAS score was 0 to 3 with an average of 1.6 points.The efficacy was evaluated by the Sanders scoring standard after hip injury:excellent in 6 cases,good in 1 case and fair in 1 case.The efficacy was all excellent according to the bone scoring standard proposed by Paley et al.All patients achieved clinical bone healing during the follow-up period.The healing time was 6 to 16 months,with an average of(8.8±2.7)months.Conclusions Masquelet technique combined with internal fixation can effectively control infection,promote bone defect healing and improve hip joint function in the treatment of subtrochanteric bone nonunion.
Keywords：Femoral fracturesFracturesununitedInternal fixatorsMembrane induction technique
Publication Date：2025-03-19
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 193-199 )