Bone Abstracts

Introduction: Segmental bone defects arising from traumatic injuries is a complicated problem with significant long term morbidity. Amputation was the preferred treatment historically. Limb salvage by the Ilizarov technique, vascularized fibular graft, and acute limb shortening was used in the last century with variable results. The problems were long, cumbersome and patient unfriendly treatment regimens, often involving multiple major and minor surgical procedures and numerous complications. More recently Masquelet et al described the use of an antibiotic cement spacer after a thorough debridement for an induced bio-membrane, followed by grafting (with or without mechanical support) within this space with successful outcomes. Similar results could not be reported at multiple centers and it was suggested that the reason was the damage sustained to the biomembrane while removal of the cement. We present our series describing our technique of cementation and cement retrieval which was able to maintain the biomembrane without damage.

Methodology and results: Our study was a retrospective case series (Level of Evidence IV) of six patients with a mean age of 47 with a mean bone defect of 8.8 cm (after debridement). Our technique involved a thorough aggressive debridement of bone and soft tissues, with filling of defect with antibiotic impregnated polymethylmethacrylate bone cement spacer, while maintaining the vascularized soft tissue sleeve, with temporary stabilisation on first presentation. This was followed by second stage removal of cement spacer while maintaining the biomembrane & cancellous bone grafting of the defect with definitive fixation. The average time for bony union was 8 months since first presentation with a mean follow up of 1 year. All patients returned to their preinjury functional level.

Conclusion: The technique of delayed bone grafting with fixation after initial debridement and placement of a cement spacer provides excellent results for patients with large posttraumatic bone segment loss.