A High-Energy Military Femoral Fracture With Multidrug-Resistant Infection: A Case Report.

BACKGROUND The Masquelet induced membrane technique is a 2-stage surgical procedure used to reconstruct large bone defects and uses a temporary cement spacer to generate a biologically active, vascularized membrane that promotes bone healing when filled with an autograft. This report describes the case of a 37-year-old military man with a high-energy femoral fracture, multiple debridement procedures, and a bone defect managed with the Masquelet induced membrane technique. CASE REPORT In the patient's home country, life-saving surgery was performed, followed by repeated excision of damaged tissue and long-term treatment, including the use of an external fixation device. After 6 months, the patient was transferred to Latvia for rehabilitation. In March 2023, he was admitted from a rehabilitation center to Riga East Clinical University Hospital in an acute setting, presenting with severe pain and purulent discharge from the left thigh. During treatment, he underwent multiple debridement procedures, insertion of a cement-coated nail, and defect reconstruction using the Masquelet induced membrane technique. Due to shortening of the affected limb, post-traumatic osteoarthritis, and poor bone quality, further osteosynthesis and stable implant fixation in the proximal femur were not feasible. Consequently, cementless left hip arthroplasty using a revision femoral stem was performed. CONCLUSIONS This case demonstrates that staged orthopedic management combining the Masquelet induced membrane technique, cementless revision hip arthroplasty, and individualized antimicrobial therapy guided by infectious disease consultation can achieve a favorable functional outcome at 2-year follow-up in a patient with high-energy femoral trauma complicated by multidrug-resistant infection.