Intramedullary Nails Yield Superior Results Compared With Plate Fixation When Using the Masquelet Technique in the...

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Bone defect reconstruction

Background:

• Critical bone defects pose significant challenges in orthopedic and trauma surgery.
• The Masquelet technique, involving induced membrane formation, is a viable option for managing large bone defects.
• Optimal internal fixation for the Masquelet technique remains a subject of investigation.

Purpose of the Study:

• To compare the efficacy of intramedullary nail (IMN) fixation versus plate fixation (PF) in treating critical bone defects using the Masquelet technique.
• To identify the preferred fixation method for improved outcomes in Masquelet reconstructions.

Main Methods:

• Retrospective cohort study conducted across four Level 1 Academic Trauma Centers.
• Included 121 patients with critical bone defects treated with the Masquelet technique between 2005 and 2018.
• Compared outcomes between patients treated with IMN (n=57) and PF (n=64).

Main Results:

• Intramedullary nail fixation was associated with significantly fewer multiple grafting procedures (10.5% vs. 28.1%, P=0.015) and overall reoperations (17.5% vs. 46.9%, P=0.001) compared to plate fixation.
• Patients treated with IMN achieved weight-bearing significantly faster (2.44 months vs. 4.63 months, P=0.002).
• Multivariable analysis indicated PF was 6.4 times more likely to require multiple grafts and 7.7 times more likely to require reoperation than IMN.

Conclusions:

• Intramedullary nail fixation demonstrates superior outcomes compared to plate fixation when used with the Masquelet technique for critical bone defects.
• The biomechanical advantages of IMN, including canal development and circumferential stress, likely contribute to faster union and reduced complications.
• IMN is recommended as the preferred fixation method for tibial and femoral defects treated with the Masquelet technique.