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5Treatment - management of the fracture wound

Dead space in bone

A significant bone defect may be filled with antibiotic beads, or other space fillers.
Recently, the technique of Masquelet has become popular. This involves the insertion into the bony defect of a solid antibiotic-containing cement spacer, which is left in place for 6-8 weeks while a membrane develops around it. The spacer is then removed and the surrounding membrane is filled with autologous bone graft. (The membrane has been studied extensively and it has been suggested that this membrane has osteogenic capacity.) This often consolidates when used for small to medium-size defects.

For more details see: Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R (2011) Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury 42(6):591-8. Case taken from article with permission from Elsevier.