Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects

Recently we modified the Masquelet technique by using an antibiotic cement-coated locking plate as a temporary internal fixator when treating septic bone defects. This modification is in order to prevent the complications related to external fixator use and provides the involved limb with a greater stability to undergo earlier and more vigorous physical therapy for recovery of joint function. The purpose of this study was to assess the outcomes of large femoral osteomyelitis defects managed by Masquelet technique combined with the antibiotic cement-coated locking plate used as a temporary internal fixator.

Between November 2013 to November 2014, 13 cases of large femoral osteomyelitis defects were treated by Masquelet technique and the antibiotic cement-coated locking plate was used as a temporary internal fixator in the first stage surgery. All the patients' clinical and imaging results were retrospectively analyzed.

After debridement, there was a femoral bone defect with a mean of 9.8 cm (range, 5-16 cm). The mean follow-up was 17.8 months (range 12 to 24 months). One patient developed infection in nine months after second stage surgery. Radiographic bony union was achieved within a mean 20.3 weeks (range, 18-30 weeks) in all patients. The mean time period to full weight bearing after the second step procedure was 5.8 months (range, 5-8.5 months). The mean knee range of motion for the patients at the last follow up was 122° (range 100-135°).

Based on our experience, we believe that antibiotic cement-coated locking plate is a viable fixation method in the first stage of Masquelet technique for the management of large femoral osteomyelitis defects. It may offer a better chance of infection eradication as well as improved recovery of joint function without increasing the infection recurrence rate and without compromising bone graft union.