Comparative analysis of the clinical efficiency of the combined Ilizarov – Masquelet technology and non-free Ilizarov bone grafting in patients with segmental tibial defects in the conditions of active purulent infection and its remission

Introduction. There is currently no consensus on the effectiveness of the Ilizarovor Masquelet technologies, and their combination in long bone defect management. The greatest challenge is restorative treatment for patients with bone defects accompanied by purulent infection, both during remission and exacerbation of the inflammatory process.

The aim of the work is a comparative analysis of the effectiveness of the combined use of the Ilizarov non-free bone grafting and the Masquelet technique versus the classical Ilizarov bone transport in patients with bone defects of the tibia in the conditions of active purulent infection and its remission.

Materials and Methods. This study is based on the analysis of the results of a multicenter study of the restorative treatment of 56 patients who underwent a combination of the Ilizarov non-free bone grafting and the Masquelet technique for tibia defects in the presence of osteomyelitis remission (Group 1, n = 33) and active infection (Group 2, n = 10), as well as the classical Ilizarov bone transport technique in the presence of active infection (Group 3, n = 13).

Results. The conditions for bone transport predetermined different durations of the transosseous osteosynthesis stages for filling similar-sized defects in the tibia. In Groups 1 and 2 (combined technology), the duration of the osteosynthesis stages was quite comparable. In the patients of Group 1, the transport of the fragments continued for (62.4 ± 10.4) days, the fixation stage was (163.4 ± 5.6) days. The duration of distraction in patients of Group 2 was (63.9 ± 15.2) days, the fixation period was (150.5 ± 19.4) days. Surgical rehabilitation of the patients in Group 3 took a longer time: distraction was performed for (115.3 ± 37.5) days, and additional (331.9 ± 122.9) days were required for restoration of the bone skeleton of the tibia. In two patients in Group 1 (7.4 %) and two individuals in Group 2 (20 %), wounds healed by secondary intention, with fistula formation. A recurrence of purulent infection was noted within one year after dismantling of the fixator and removal of the transosseous fixation elements, requiring minor surgical debridement and antibacterial therapy. Complete suppression and eradication of purulent infection was not achieved in one patient in Group 2. No recurrence of purulent infection was observed in Group 3 patients during follow-up.

Discussion. The combination of the Masquelet technique and Ilizarov non-free bone grafting, despite the implantation of spacers with a prophylactic dose of antibiotics and empirical antibacterial therapy, does not guarantee the elimination of the risk of purulent recurrence if debridement of infected areas is not complete. However, combining the Masquelet technique and Ilizarov non-free bone grafting, the formation of an induced membrane creates favorable conditions for Ilizarov bone transport during the second stage of surgical treatment.

Conclusion A comparative analysis of surgical rehabilitation of patients using the Ilizarov non-free bone grafting and the combined use of Ilizarov bone transport and the Masquelet technique in patients with bone defects of the tibia with active purulent infection and its remission showed that the treatment period in the classical Ilizarov bone transport method was longer, but it did not result in recurrence of the purulent process. Guaranteed arrest of purulent infection is only possible after radical surgical debridement and debridement of the purulent bone wound.

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