Induced membrane maintains its osteogenic properties even when the second stage of Masquelet’s technique is performed later

  • Florelle GindrauxEmail author
  • François Loisel
  • Michael Bourgeois
  • Karim Oudina
  • Martine Melin
  • Benoit de Billy
  • Pauline Sergent
  • Gregoire Leclerc
  • Hervé Petite
  • Frederic Auber
  • Laurent Obert
  • Isabelle Pluvy
Original Article



Previous clinical studies have shown the effectiveness of bone repair using two-stage surgery called the induced membrane (IM) technique. The optimal wait before the second surgery is said to be 1 month. We have been successfully performing the IM technique while waiting an average of 6 months to carry out the second stage. We hypothesised that the IM maintains its beneficial capabilities, even at a later second stage, and that there is no relation between the speed of bone union and the wait between the first and second stage. We sought to explore the biological properties of ‘older’ IMs sampled to substantiate our clinical observations.


Thirty-four patients with a critical size defect were treated with the IM technique. In seven of these patients, pieces of the IM were collected 4.2–14.7 months after the first surgery. IM-derived cell phenotype and osteogenic potential were investigated using in vitro studies (n = 4) while IM nature and function were investigated by histology and immunohistochemistry (n = 3).


The median wait before the second surgery was 5.8 months [range 1.2–14.7] and bone healing occurred at 7.6 months [range 2.5–49.9] for 26 patients. IMs aged 4.2–14.7 months contained mesenchymal stromal cells with in vitro osteogenic potential and corresponded to a multipotent tissue with osteogenic and chondrogenic capabilities contributing to osteogenesis over time.


This preliminary study suggests the IM retains its powerful osteogenic properties over time and that waiting longer between the two surgeries does not delay bone union.


Bone union Induced membrane Experimental studies Multipotent tissue 



The authors thank Fiona Ecarnot (EA3920, University Hospital Besancon, France) and Joanne Archambault, PhD for editorial assistance.

Compliance with ethical standards

Conflict of interest

The authors confirm that there are no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019
corrected publication 2019

Authors and Affiliations

  • Florelle Gindraux
    • 1
    • 2
    Email author
  • François Loisel
    • 1
    • 2
  • Michael Bourgeois
    • 1
  • Karim Oudina
    • 3
  • Martine Melin
    • 4
  • Benoit de Billy
    • 2
    • 5
  • Pauline Sergent
    • 1
  • Gregoire Leclerc
    • 1
  • Hervé Petite
    • 3
  • Frederic Auber
    • 2
    • 5
  • Laurent Obert
    • 1
    • 2
  • Isabelle Pluvy
    • 1
    • 2
  1. 1.Orthopaedic and Traumatology Surgery DepartmentUniversity Hospital of BesanconBesanconFrance
  2. 2.Nanomedicine Lab, Imagery and Therapeutics (EA 4662), SFR FED 4234University of Franche-ComtéBesanconFrance
  3. 3.Laboratory of Bioengineering and Biomechanics for Bone Articulation (B2OA-UMR CNRS 7052)University Paris DiderotParisFrance
  4. 4.NovotecBronFrance
  5. 5.Paediatric Surgery DepartmentUniversity Hospital of BesanconBesanconFrance

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