Management of open periprosthetic distal femoral fracture using a novel hybrid technique combining Masquelet and DAIR procedure: A case report.

Introduction: Periprosthetic distal femoral fractures (PPDFF) present complex clinical challenges, particularly when accompanied by open injuries and significant bone loss. Conventional treatments, including open reduction and internal fixation (ORIF) or distal femoral replacement (DFR), carry high complication rates such as infection, non-union, and implant failure. This report describes a novel hybrid approach combining the Masquelet technique with Debridement, Antibiotics, and Implant Retention (DAIR) for managing open PPDFF.

Case Presentation: A 74-year-old female patient with a prior total knee arthroplasty sustained a Gustilo-Anderson type 3A open PPDFF (AO/OTA 33A3.2) following a motor vehicle accident. Due to the extent of comminution and bone defect, a two-stage procedure was performed. The first stage included thorough debridement, stabilization using a dynamic condylar screw, and placement of antibiotic-laden polymethylmethacrylate beads. Two months later, the spacer was removed, definitive fixation with a locking plate and autologous iliac crest bone grafting was completed, and the polyethylene insert was upsized to correct an extension gap.

Discussion: This combined Masquelet and DAIR approach effectively managed bone loss, controlled infection, preserved the original prosthetic components, and led to excellent functional recovery. Compared to conventional methods, this hybrid technique may reduce morbidity and complication rates, showing promise for complex open PPDFF cases.

Conclusion: The novel hybrid Masquelet-DAIR technique offers an effective solution for managing complex open periprosthetic distal femoral fractures, providing robust infection control, structural reconstruction, and optimal outcomes. Further studies with larger cohorts are recommended to validate these findings.