Outcomes of Infected Non-unions of Distal Femur Managed with the Masquelet Method and Ilizarov Ring Fixator

Distal femur infected non-union management is very challenging especially when there is late presentation and after multiple intervention. Various methods have been described and studied in the literature for infected non-union of femur which includes bone transport by fixators (ring fixators/monolateral frames) and by Masquelet method.

To study the clinical and radiological outcomes and study the effect on quality of life by patient-reported outcomes (EQ5D5L) and VAS (Visual Analog Scale) score in patients of infected non-union of distal femur managed with combination of Masquelet method and Ilizarov ring fixator.

Eleven patients aged between 18 and 60 years, both sexes, presenting with infected non-union of distal femur were considered for the study. Average findings were: time of presentation-56 weeks post-injury, number of previous surgeries-2.1, bone loss after debridement-8.5 cm, pre-operative VAS score-8.4, pre-operative EQ5D5L score-21.4, ISS-55.6, NUSS-56.54. Surgery was performed in two stages. Stage one involved debridement, application of a knee-spanning ring fixator, a vancomycin-loaded poly methyl methacrylate cement spacer, and closure, with corticotomy performed in some patients during this or the second stage.

The three patients (27.3%) had graft infection and underwent gradual docking after debridement. The results calculated for eight patients (without graft infection 72.7%) are as follows: Average ROM of knee 0 to 29.3degrees, external fixator duration was 48.1 weeks, union time was 27.5 weeks, VAS score was 1.9, immediate post-operative and 6 months frame removal EQ5D5L scores were 13.8 and 10.6, respectively. ASAMI bone score was excellent in five (62.5%), good in two (25%), and fair in one (12.5%). ASAMI functional score was excellent in one (12.5%), good in six (75%), and fair in one (12.5%).

Masquelet method with stabilization using Ilizarov ring fixator with or without lengthening can give promising results in patients with less infection severity score. Patients with high score should be managed by only fixators (ring/monolateral).

The online version contains supplementary material available at 10.1007/s43465-024-01279-0.