Satish Koti1, Naresh Kumar Eamani2, Ravi Shankar Penugonda3, Vidya Sagar S4, Suresh Babu Gangireddi5
BACKGROUND
Management of segmental long bone defects is a challenging task. Attempting limb reconstruction in the presence of significant bone loss usually involves surgery, which is technically difficult, time-consuming, physically and psychologically demanding for the patient, and with no guarantee of a satisfactory outcome. Amputation, external fixators, vascularised fibular grafts, acute limb shortening, and various quantities of allograft and autograft have historically been the mainstays of treatment. For the past 4 decades, Vascularised Fibular Grafting (VFG) and distraction osteosynthesis with ring external factor (Ilizarov technique) stood the test of time to become standard techniques for the management of large long bone defects. More recently, Masquelet described the use of a cement spacer placed within the osseous void followed by staged bone grafting within the induced biomembrane formed around the spacer as a potential treatment strategy to manage these large defects. The main aim of the study is to compare the efficacy of the two philosophically different methods, conventional distraction osteosynthesis, and Masquelet technique in the management of tibial bone defect incurred due to traumatic bone loss, traumatic fractures complicated by infection, and chronic osteomyelitis of tibia.
METHOD
Prospective observational study on male and female patients admitted in the Department of Orthopaedics in our tertiary level hospital from November 2012 to September 2014. All patients who have tibial bone defect incurred due to traumatic bone loss, traumatic fractures complicated by infection, and chronic osteomyelitis of tibia are included in the study. Children of age less than 5 years and elderly patients of age more than 85 years are excluded from the present study. Patients with tibial bone defects resulting from injury or surgical intervention are selected into the study and assigned either group D or group M. The patients in group D (n=15) are treated by conventional distraction osteosynthesis while the patients in the group M (n=10) are treated by Masquelet’s technique. Patient demographics, radiological bone union rates, time taken to achieve bone union, and infection rates and their statistical significances are compared to come to a scientific conclusion.
RESULTS
The study was done over a period of 2 years (November 2012 to September 2014). During this period, we observed 25 cases of tibial bone defects, which were managed by either distraction osteogenesis (Group D:15 cases) or Masquelet technique (Group M:10 cases). In our study, the mean age of group D and group M were 40.9 years (SD±9.89) and 37.8 years (9.13) respectively. In the present study, most of the patients belong to male gender in either groups (8 in group M and 13 in group D). Female gender has 2 patients in either group. In the present study, we observed trauma with infection (46.66%) and trauma (40%) were common aetiological causes for tibial bone defects. There was no significant difference in defect size between the two groups (p=0.889). There was no significant difference between the union rates between the two groups (p=0.358). There was a statistically significant lower duration of union time in group D (p=0.045).There was no statistically significant difference in postoperative infections between the two groups (p=0.175). In group D, two different techniques were done (Compression distraction technique and bone transport technique). On comparing the union rates in both subgroups in group D, there was no statistically significant difference (p=1.0). There was a statistically significant strongly positive correlation between tibial bone defect size and time taken for union in group D, which was not so in group M.
CONCLUSION
Masquelet two-stage technique for management of defect nonunions is a relatively newer technique with its own share of technical difficulty and disadvantages. This technique requires a lot of improvisation to improve the outcome. This technique can be an efficient alternative to cumbersome conventional techniques of treating defect nonunions.
