A novel primary antibiotic cement-coated locking plate as a temporary fixation for the treatment of open tibial fracture

Abstract

Abstract Despite advances in Masquelet techniques of bone transfer, complex lower extremity trauma reconstruction remains a challenge. Herein, we present the use of a modified version of the Acute Masquelet technique to treat Grade III open fractures of the lower extremity. This modification can reduce the treatment period and complications of external fixation. We aimed to assess the outcomes of this technique for open fractures with bone and soft tissue defects. Between January 2018 and March 2021, 20 patients with Gustilo grade IIIB/C open fractures were treated with an antibiotic cement-coated locking plate as a temporary internal fixator during the initial surgery stage. Thorough debridement was performed in the emergency department, and temporary internal fixation was performed with a 3.5-mm system antibiotic cement-coated locking plate. Ten patients required free bone fragment removal, followed by bone cement packing. The final stage involved internal fixation and wound repair with a free anterolateral thigh flap. Clinical and imaging results were retrospectively analysed. The repair time ranged from 1 to 7 days. All flaps survived. Two patients experienced wound infection, and one developed severe bone infection 3 months after three-stage bone graft surgery. Autologous cancellous bone grafting was performed on ten patients with bone defects 6 weeks after surgery. Bone union was universally achieved after 1 year. This method proved to be safe and effective, with the repair of Grade III open fractures of the lower extremity achieved 1 to 7 days after treatment.