Abstract
Background
Surgical reconstruction of segmental skeletal defects represents a true challenge for the orthopedic surgeons. Recently, Masquelet et al. described a two-stage technique for reconstruction of bone defects, known as the induced membrane technique. The aim of this study is to assess the results of the induced membrane technique in the management of segmental skeletal defects resulting from debridement of bone infection.
Materials and Methods
Seventeen patients with segmental skeletal defects were treated in our institution by the induced membrane technique. The average age of the patients was 43 years (range 26–58 years). The causes of the defects were infected gap nonunion in 12 cases and debridement of osteomyelitis in 5 cases. The defects were located in the tibia (n = 13) and the femur (n = 4). The mean defect was 7 cm (range 4 cm–11 cm). All cases were treated by the induced membrane technique in two-stages.
Results
Bone union happened in 14 patients. The limb length discrepancy did not exceed 2.5 cm in the healed cases. The mean time of healing was 10 months (range 6-19 months). The complications included nonunion of the graft in five cases, failure of graft maturation in two cases, reactivation of infection in two cases and refracture after removal of the frame in one case. These complications were managed during the course of treatment and they did not affect the final outcome in all patients except three.
Conclusion
The induced membrane technique is a valid option for the management of segmental skeletal defects. It is a simple and straight forward procedure, but the time required for growth and maturation of the graft is relatively long.
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References
DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 2004;12:28–38.
Ilizarov GA, Ledyaev VI. The replacement of long tubular bone defects by lengthening distraction osteotomy of one of the fragments 1969. Clin Orthop Relat Res 1992;7–10.
Levin LS. Vascularized fibula graft for the traumatically induced long-bone defect. J Am Acad Orthop Surg 2006;14:S175–6.
Masquelet AC, Fitoussi F, Begue T, Muller GP. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet 2000;45:346–53.
Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 2010;41:27–37.
Pelissier P, Masquelet AC, Bareille R, Pelissier SM, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 2004;22:73–9.
Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC, French Society of Orthopaedic Surgery and Traumatology (SoFCOT). Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 2012;98:97–102.
Chotel F, Nguiabanda L, Braillon P, Kohler R, Bérard J, Abelin-Genevois K. Induced membrane technique for reconstruction after bone tumor resection in children: A preliminary study. Orthop Traumatol Surg Res 2012;98:301–8.
Dahl MT, Gulli B, Berg T. Complications of limb lengthening. A learning curve. Clin Orthop Relat Res 1994;10–8.
Paley D. Problems, obstacles, and complications of limb lengthening by the Ilizarov technique. Clin Orthop Relat Res 1990;81–104.
Viateau V, Guillemin G, Calando Y, Logeart D, Oudina K, Sedel L, et al. Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: An ovine model. Vet Surg 2006;35:445–52.
Aho OM, Lehenkari P, Ristiniemi J, Lehtonen S, Risteli J, Leskelä HV. The mechanism of action of induced membranes in bone repair. J Bone Joint Surg Am 2013;95:597–604.
Polyzois D, Papachristou G, Kotsiopoulos K, Plessas S. Treatment of tibial and femoral bone loss by distraction osteogenesis. Experience in 28 infected and 14 clean cases. Acta Orthop Scand Suppl 1997;275:84–8.
Song HR, Cho SH, Koo KH, Jeong ST, Park YJ, Ko JH. Tibial bone defects treated by internal bone transport using the Ilizarov method. Int Orthop 1998;22:293–7.
Megas P, Saridis A, Kouzelis A, Kallivokas A, Mylonas S, Tyllianakis M. The treatment of infected nonunion of the tibia following intramedullary nailing by the Ilizarov method. Injury 2010;41:294–9.
Woon CY, Chong KW, Wong MK. Induced membranes–A staged technique of bone-grafting for segmental bone loss: A report of two cases and a literature review. J Bone Joint Surg Am 2010;92:196–201.
Apard T, Bigorre N, Cronier P, Duteille F, Bizot P, Massin P. Two-stage reconstruction of posttraumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res 2010;96:549–53.
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El-Alfy, B.S., Ali, A.M. Management of segmental skeletal defects by the induced membrane technique. IJOO 49, 643–648 (2015). https://doi.org/10.4103/0019-5413.168757
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DOI: https://doi.org/10.4103/0019-5413.168757