Centromedullary nailing during the second stage of induced membrane (Masquelet) for tibia septic nonunion enables bone union to be achieved without increasing the risk of recurrence of infection, with an earlier return to weight-bearing - 24/12/24

Doi : 10.1016/j.otsr.2024.104118

Marie Le Baron ^a,⁎ , Mathieu Cermolacce ^a,^b, Julie Falguières ^c, Richard Volpi ^a, Pascal Maman ^a, Xavier Flecher ^a
^a Service de Chirurgie Orthopédique, Hôpital Nord, Pôle Locomoteur, Assistance Publique-Hôpitaux de Marseille, Institut du Mouvement et de l’Appareil Locomoteur, Marseille, France
^b ICOS 13, Clinique Juge, Marseille, France
^c Service de Chirurgie Orthopédique, Centre Hospitalier de Béziers, Béziers, France

^⁎Corresponding author.

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Tuesday 24 December 2024

Abstract

Introduction

Septic nonunion is one of the most feared complications in traumatology. Two-stage management using the induced membrane technique is a validated treatment option, but to date there is no consensus on the ideal type of osteosynthesis for the second stage of surgery. The aim of this study was to compare the results of two-stage treatment of tibial septic nonunion, depending on the type of osteosynthesis used.

Hypothesis

Our hypothesis was that internal centromedullary nailing osteosynthesis during the second stage of management of septic tibia nonunion would achieve bone union and healing of the infection, while allowing faster resumption of weight-bearing without increasing the complication rate.

Material & methods

This was a retrospective monocentric continuous comparative study including all 2-stage tibial septic nonunions treated from January 2008 to July 2018, with a minimum follow-up of 18 months. Healing and septic reactivation rates, as well as time to union and weight-bearing on the limb, were compared according to the type of osteosynthesis used. Primary success was defined as recovery from septic nonunion, and secondary success as recovery after at least one additional surgical procedure.

Results

Forty-nine patients were included, aged 39.5 +/− 14.8 years. Primary and secondary success rates were 77.6% (38/49) and 87.8% (43/49), with a mean follow-up of 29.4 +/− 11.3 months. Internal osteosynthesis did not lead to more septic reactivation than external stabilization (p = 0.49), while allowing union within the same deadlines. Osteosynthesis with a centromedullary nail allowed earlier weight-bearing (1.5 +/− 0.9 months) vs. plate (4.8 +/− 1.5) or vs. external fixator (5.3 +/− 1.8) (p < 0.001).

Conclusion

Secondary conversion to internal osteosynthesis during the second stage of nonunion cure allows consolidation in same delays, without increasing the risk of infectious recurrence. It also enables faster weight-bearing on the operated limb, particularly in the case of centromedullary nailing.