Management of an 11-cm Femoral Diaphyseal Defect Secondary to Chronic Osteomyelitis Using the Induced Membrane Technique in a 14-Year-Old Girl: A Case Report.

BACKGROUND Management of infected segmental defects of the femoral diaphysis is challenging because infection control, restoration of stability, and reconstruction of bone loss must all be achieved. The induced membrane technique, also known as the Masquelet technique, is a 2-stage reconstructive method for large post-infectious bone defects. This report describes reconstruction of an 11-cm femoral diaphyseal defect secondary to chronic osteomyelitis in a 14-year-old girl. CASE REPORT A 14-year-old girl sustained a Gustilo-Anderson type II open fracture of the right femoral shaft after a motor vehicle accident and initially underwent debridement and external fixation. During follow-up, pin-site infection developed, and infected nonunion with chronic osteomyelitis was diagnosed 6 months after injury. At the first stage, the external fixator was removed, radical debridement and sequestrectomy were performed, and an 11-cm segment of necrotic femoral diaphysis was resected until punctate cortical bleeding ("paprika sign") was observed. A vancomycin-loaded polymethylmethacrylate cement spacer was placed around a locked intramedullary nail. Nearly 3 months later, second-stage reconstruction was performed, with removal of the spacer, repeat intramedullary fixation, and autologous bone grafting using a reamer-irrigator-aspirator system combined with iliac cancellous bone. At 6 months after the second-stage procedure, the patient was fully weight-bearing, had resumed normal daily activities, and showed radiographic bone healing without recurrent infection. CONCLUSIONS The induced membrane technique may be an effective option for staged reconstruction of a large post-infectious femoral diaphyseal defect in an adolescent when thorough debridement, stable fixation, and adequate autologous bone grafting are achieved.