Clinical effects of early debridement, internal fixation, and Masquelet technique for childhood chronic haematogenous osteomyelitis of long bones

• DOI: 10.1186/s13018-022-03478-7
• Publication Date: 2023-01-05T08:04:08Z
• Authors: Jian Shi; Xiaoyong Yang; Muguo Song; Xijiao Zhang; Yongqing Xu
• Keywords: Male; Diseases of the musculoskeletal system; Fracture Fixation, Internal; 03 medical and health sciences; 0302 clinical medicine; Humans; Chronic osteomyelitis; Child; Retrospective Studies; Orthopedic surgery; Bone Transplantation; Masquelet technique; Osteomyelitis; Internal fixation; Anti-Bacterial Agents; 3. Good health; Treatment Outcome; RC925-935; Debridement; Paediatric; Female; Persistent Infection; RD701-811; Research Article

Abstract Background Childhood chronic haematogenous osteomyelitis (CCHOM) is a severe condition in paediatric patients. The optimal timing of debridement and the subsequent method of bone reconstruction in CCHOM patients remain controversial. The purpose of this study was to assess the treatment efficacy of Masquelet technique with early debridement and internal fixation in CCHOM of long bones.

Methods Between January 2016 and January 2021, a total of 21 patients (18 males, 3 females) with CCHOM of long bone were included. The mean age was 10.4 years (range, 2–18 years). All cases were treated by a two-stage surgical protocol of Masquelet technique. In the first stage, aggressive debridement, sequestrectomy, and inducing membrane by bone cement spacer were performed after definite diagnosis. In the second stage, cement spacer was removed, and autologous and allogeneic bone was grafted. Internal fixation was used for the first and/or second stage depending on stability requirements. The patients’ clinical and imaging results were retrospectively analysed.

Results The mean follow-up was 31.7 months (range, 21–61 months). None of the patients experienced recurrence of infection. Radiographic bone union time was 4.3 months (range, 2.5–11 months). Five cases underwent re-operation due to complications such as bone resorption or refracture. By the last follow-up visit, bones had healed and all of the patients had resumed daily living and sports activities.

Conclusion The Masquelet technique with early debridement and internal fixation is a viable surgical method for the management of large long bone defects of CCHOM patients.