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Introduction: The masquelet technique is a two-stage procedure used by orthopedic surgeons to treat large segmental bone defects secondary to infection, trauma, and tumor resection. This technique characteristically requires the placement of a temporary cement spacer and subsequent bone grafting for complete reconstruction. We describe a unique case of segmental bone loss reconstruction in which a patient successfully achieved fracture union after the first step of the masquelet technique without bone grafting. Case Report: This is a case of a 21-year-old male who presented with an open femur fracture with 10 cm of segmental bone loss after a motorcycle collision. An antibiotic cement spacer was inserted according to the first stage of the masquelet technique. Due to considerable callus formation around the spacer, normal alignment, and pain-free ambulation at follow-up, further surgical intervention was not pursued, and the poly-methyl-methacrylate spacer was left in place. The fracture healed without infection, and the patient remained weight-bearing without pain. Conclusion: This case identifies a unique instance of successful fracture union of a 10 cm segmental bone defect despite the completion of only the first step in the masquelet procedure. While the masquelet technique is believed to be a mandatory two-step procedure, this unique case of rapid bone growth and fracture union warrants further research on the possibilities of masquelet-induced regeneration without bone grafting.
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Introduction: Baker's cysts are benign fluid-filled cysts that commonly form around knee joints which typically resolve spontaneously. Infection of baker's cysts is uncommon, but most often associated with septic arthritis or bacteremia. We describe a unique case of an infected Baker's cyst that presented without bacteremia, septic knee, or external source of infection. This is a rare manifestation that has not been described in the current literature. Case Report: This is a case of a 46 year-old woman who developed an infected Baker's cyst without bacteremia or septic arthritis. She initially presented with the right knee pain, swelling, and limited range of motion. Blood work and synovial fluid aspiration of her right knee showed no source of infection. The patient subsequently developed erythema and tenderness over her right knee. This prompted MRI imaging that demonstrated a complex Baker's cyst. The patient later developed a fever, tachycardia, and worsening anion-gap metabolic-acidosis. Aspiration of the fluid collection was performed and revealed purulent fluid which grew pansensitive Methicillin-Sensitive Staphylococcus aureus, blood and knee aspiration cultures remained negative. The patient was treated with antibiotics and debridement procedures and her symptoms/infection resolved. Conclusion: Given that isolated infections of Baker's cysts are rare, the localized aspect of this infection makes this case quite unique. Development of an infected Baker's cyst after negative aspiration cultures, combined with the presence of systemic symptoms including fever, without evidence of systemic spread, has not been seen before in the literature to our knowledge. The unique presentation of this case is important for future analysis of Baker's cysts as it introduces the possibility of localized cyst infections as a possible diagnosis for physicians to consider.
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Although females have a higher rate of primary total joint arthroplasty (TJA), males have a higher rate of revision. The literature lacks studies examining the relationship between sex and outcomes following single and two-stage exchange for periprosthetic joint infection (PJI). The purpose of this study was to examine if differences exist in outcomes following revision for chronic PJI between sexes. A retrospective review was performed on all patients with an MSIS confirmed PJI who underwent a single or two-stage exchange at our institution from January 2010 to January 2021. Patient demographics, comorbidity characteristics, and outcomes were collected and compared between males and females. The primary outcome variable was disease-free survival at 1 year following definitive revision. Multivariable logistic regression analysis was performed to determine risk factors for failure. Of the 470 patients meeting final eligibility criteria, 250 were male and 226 were female (2 males and 4 females had a joint infection of either the contralateral side or a different joint and were treated as separate records). Of the patients in the cohort, 80% of the males (200/250) and 80% of the females (181/226) were found to be disease-free at 1-year follow-up (p > 0.99). Multivariable logistic regression analysis showed that nicotine use and diabetes, but not sex, were significant predictors of failure. Our study did not find a relationship between sex and outcome of revision for PJI. Further research is required to determine whether differences exist between males and females in the expression of PJI and outcomes following treatment.