title: [Tibial defects and infected non-unions : Treatment results after Masquelet technique].
abstract: BACKGROUND
  The treatment of non-unions with large bone defects or osteitis is a major challenge in orthopedic and trauma surgery. A new concept of therapy is a two-step procedure: Masquelet technique according to the diamond concept.
  
  
  METHODS
  Between February 2010 and June 2014, 55 patients with tibia non-unions or infections were treated in a two-step Masquelet technique in our center. The patients' average age was 48 (median 50; minimum 15-maximum 72) with an average BMI (body mass index) of 28 (27; 18-52). There were 10 (18 %) female and 45 (82 %) male patients in the group. All study patients went through a follow up. Bone healing and clinical functional data were collected, as well as data according to subjective patient statements about pain and everyday limitations.
  
  
  RESULTS
  In 42 cases (76.4 %) the outcome was a sufficient bony consolidation. On average, the time to heal was 10.3 (8, 5; 3-40) months, defect gaps were 4 cm (3 cm; 0,6-26 cm), and on average the patients had had 6 (median 4; range 1-31) previous operations . In all cases patients received osteosynthesis as well as a defect filling with RIA (reamer-irrigator-aspirator), and growth factor BMP-7 (bone morphogenetic protein-7). In 13 cases (23.6 %) there was no therapeutic success. In the evaluation of the SF12 questionnaire the mental health score increased from 47.4 (49.1; 27.6-65.7) to 49.8 (53.0; 28.7-69.4) and the well-being score from 32.7 (32.7;16.9-55.7) to 36.6 (36.5; 24.6-55.9).
  
  
  CONCLUSIONS
  The two-step bone grafting method in the Masquelet technique used for tibia non-unions according to the diamond concept is a promising treatment option. Its application for tibia shaft non-unions with large bone defects or infections means a high degree of safety for the patient.
authors: HTRG-Heidelberg Trauma Research Group, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland. Arash.Moghaddam@med.uni-heidelberg.de.
authors: A
authors: A
authors: Moghaddam
authors: HTRG-Heidelberg Trauma Research Group, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
authors: C
authors: C
authors: Ermisch
authors: HTRG-Heidelberg Trauma Research Group, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
authors: C
authors: C
authors: Fischer
authors: HTRG-Heidelberg Trauma Research Group, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
authors: S
authors: S
authors: Zietzschmann
authors: HTRG-Heidelberg Trauma Research Group, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
authors: G
authors: G
authors: Schmidmaier
mesh_terms: D000293:Adolescent; D000328:Adult; D001843:Bone Cements / Q000627:therapeutic use*; D016025:Bone Transplantation / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D005260:Female; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010000:Osteitis / Q000150:complications / Q000628:therapy*; D013978:Tibial Fractures / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements
keywords: BMP-7; Bone inflamation; Grafiting, bone; Orthopedic surgical procedures; Osteosynthesis, fracture