Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study

Ahmed Nageeb Mahmoud; John Tracy Watson; Daniel S Horwitz

doi:10.5005/jp-journals-10080-1604

Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study

Strategies Trauma Limb Reconstr. 2023 Sep-Dec;18(3):181-185. doi: 10.5005/jp-journals-10080-1604.

Authors

Ahmed Nageeb Mahmoud¹, John Tracy Watson², Daniel S Horwitz³

Affiliations

¹ Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States of America; Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
² Department of Orthopaedic Surgery, Saint Louis University, Saint Louis, Missouri, United States of America.
³ Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, Pennsylvania, United States of America.

Abstract

Aim: To highlight the role of the Masquelet technique as a limb salvage procedure for a neuropathic patient presenting with infected non-union of proximal tibia.

Background: The management of an infected non-union in neuropathic patients is most challenging; with various treatment options available, the prognosis is often guarded.

Case description: A 37-year-old male with chronic polyneuropathy, also possessing a contralateral midfoot Charcot arthropathy secondary to a history of alcohol abuse, developed infection after a proximal tibial osteotomy for a preceding mal-non-union of a proximal tibia fracture. The management included hardware removal, excision of necrotic bone, interim insertion of antibiotic-loaded bone cement followed by an acute shortening and revision of the internal fixation utilising a second surgical incision. Successful bone union and eradication of infection was achieved and maintained after 13 months follow-up.

Conclusion: A successful outcome was achieved for an infected non-union of a long bone in a neuropathic patient using the Masquelet technique which was then followed with a second-stage removal of the spacer and shortening. By performing the revision ORIF surgery utilising a different skin incision in the setting of complicated previous surgical scars proved to be a viable technique towards reducing risk of recurrence of infection and a good outcome.

Clinical significance: Utilisation of the Masquelet technique and limb shortening in a staged manner for the management of long bone infections in neuropathic patients has not been reported before and may be valuable in such demanding clinical situations.

How to cite this article: Mahmoud AN, Watson JT, Horwitz DS. Modified Masquelet Technique and Primary Tibial Metaphyseal Shortening for the Management of Proximal Tibial-infected Non-union in a Patient with Alcohol-induced Neuropathy: A Case Study. Strategies Trauma Limb Reconstr 2023;18(3):181-185.

Keywords: Alcohol; Infected non-union; Masquelet; Neuropathy; Tibia.

Publication types

Case Reports