Treatment of bone loss using the Masquelet technique with RIA bone graft

Publication date: Available online 3 December 2018

Source: Injury

Author(s): G.C. Salvo, S. Bonfiglio, S. Milazzo, R. Ortuso, G. Longo

Abstract

The present work will illustrate the study case of a patient who came to our attention upon arriving in the emergency room after a road accident, showing a type III B G.A. open fracture of the distal tibia with acute loss of the talus and the distal tibia comminution.

In case of a severe articular tibia-tarsic surface impairment with associated compromised soft tissue, among the therapeutic options it could be useful to consider an acute bone resection, followed by an autograft bone implant which was applied, in this specific case, with Masquelet technique using RIA.

Indeed, functional recovery and anatomic reconstruction are not an option for all the severe articular impairment cases. This frequently happens especially where biological issues, such as inadequate skin coverage, bone defects or insignificant contamination indexes, are associated with considerable exposures.

If the injury sustained involves the articular and epiphyseal regions, the combination of arthrodesis and autograft bone to fill the gap left by the loss of the metaepiphyseal bone tissue secondary to the original injury sustained and the subsequent debridement, represents a valid therapeutic alternative to have a good chance of success. However, prior to the bone grafting procedure, a spacer loaded with antibiotics would be appropriate to facilitate management of the dead space and to provide local release of antibiotics to clear the surgical site of potential septic problems

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