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International Orthopaedics

, Volume 43, Issue 1, pp 209–215 | Cite as

Induced membrane technique for the treatment of severe acute tibial bone loss: preliminary experience at medium-term follow-up

  • Mario RongaEmail author
  • Mario Cherubino
  • Katia Corona
  • Alessandro Fagetti
  • Barbara Bertani
  • Luigi Valdatta
  • Redento Mora
  • Paolo Cherubino
Original Paper
  • 119 Downloads

Abstract

Purpose

Management of acute open tibial fractures with critical bone defect remains a challenge in trauma surgery. Few and heterogeneous cases have been reported about the treatment with the induced membrane technique.

Methods

We prospectively evaluated three patients treated with the induced membrane technique for acute Gustilo IIIB tibial fractures with critical bone defect. Success treatment was defined by bone union with patient pain free. Clinical and radiological evaluations were performed regularly until healing, then annually and with a minimum follow-up of five years.

Results

In all patients but one, a success was recorded, respectively, at four and six months. These two patients were pain free until the final follow-up, and no graft resorption or secondary complications related to the index surgery were observed. The third case was managed successfully with a bone transport technique.

Conclusion

The induced membrane technique is an alternative good option for the treatment of these severe lesions.

Keywords

Open fracture Bone defect Masquelet technique Induced membrane Bone reconstruction 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Molina CS, Stinner DJ, Obremskey WT (2014) Treatment of traumatic segmental long-bone defects: a critical analysis review. JBJS Rev 2(4):1.  https://doi.org/10.2106/JBJS.RVW.M.00062 CrossRefGoogle Scholar
  2. 2.
    El-Gammal TA, Shiha A, El-Deen M, El-Deen MA, El-Sayed A, Kotb MM, Addosooki AI, Ragheb YF, Saleh WR (2008) Management of traumatic tibial defects using free vascularized fibula or ilizarov bone transport: a comparative study. Microsurgery 28(5):339–346.  https://doi.org/10.1002/micr.20501 CrossRefGoogle Scholar
  3. 3.
    Yokoyama K, Itoman M, Nakamura K, Tsukamoto T, Saita Y, Aoki S (2001) Free vascularized fibular graft vs Ilizarov method for post-traumatic tibial bone defect. J Reconstr Microsurg 17(1):17–25Google Scholar
  4. 4.
    Masquelet AC, Fitoussi F, Bégué T, Muller GP (2000) Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet 45:346–353Google Scholar
  5. 5.
    Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC (2012) Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 98:97–102.  https://doi.org/10.1016/j.otsr.2011.11.001 CrossRefGoogle Scholar
  6. 6.
    Azi ML, Teixeira AA, Cotias RB, Joeris A, Kfuri M Jr (2016) Membrane induced osteogenesis in the management of posttraumatic bone defects. J Orthop Trauma 30:545–550.  https://doi.org/10.1097/BOT.0000000000000614 CrossRefGoogle Scholar
  7. 7.
    Apard T, Bigorre N, Cronier P, Duteille F, Bizot P, Massin P (2010) Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res 96:549–553.  https://doi.org/10.1016/j.otsr.2010.02.010 CrossRefGoogle Scholar
  8. 8.
    Olesen UK, Eckardt H, Bosemark P, Paulsen AW, Dahl B, Hede A (2015) The Masquelet technique of induced membrane for healing of bone defects. A review of 8 cases. Injury 46:S44–S47.  https://doi.org/10.1016/S0020-1383(15)30054-1 CrossRefGoogle Scholar
  9. 9.
    Giannoudis PV, Harwood PJ, Tosounidis T, Kanakaris NK (2016) Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes. Injury 47:S53–S61.  https://doi.org/10.1016/S0020-1383(16)30840-3 CrossRefGoogle Scholar
  10. 10.
    Morris R, Hossain M, Evans A, Pallister I (2017) Induced membrane technique for treating tibial defects gives mixed results. Bone Joint J 99:680–685.  https://doi.org/10.1302/0301-620X.99B5.BJJ-2016-0694.R2 CrossRefGoogle Scholar
  11. 11.
    Mühlhäusser J, Winkler J, Babst R, Beeres FJP (2017) Infected tibia defect fractures treated with the Masquelet technique. Medicine 96:1–7.  https://doi.org/10.1097/MD.0000000000006948 CrossRefGoogle Scholar
  12. 12.
    Ronga M, Ferraro S, Fagetti A, Cherubino M, Valdatta L, Cherubino P (2014) Masquelet technique for the treatment of a severe acute tibial bone loss. Injury 45:S111–S115.  https://doi.org/10.1016/j.injury.2014.10.033 CrossRefGoogle Scholar
  13. 13.
    Taylor BC, Hancock J, Zitzke R, Castaneda J (2015) Treatment of bone loss with the induced membrane technique. J Orthop Trauma 29:554–557.  https://doi.org/10.1097/BOT.0000000000000338 CrossRefGoogle Scholar
  14. 14.
    Morelli I, Drago L, George DA, Gallazzi E, Scarponi S, Romanò CL (2016) Masquelet technique: myth or reality? A systematic review and meta-analysis. Injury 47:68–76.  https://doi.org/10.1016/S0020-1383(16)30842-7 CrossRefGoogle Scholar
  15. 15.
    Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41:27–37.  https://doi.org/10.1016/j.ocl.2009.07.011 CrossRefGoogle Scholar
  16. 16.
    Lasanianos NG, Kanakaris NK, Giannoudis PV (2010) Current management of long bone large segmental defects. Orthop Trauma 24(2):149–163.  https://doi.org/10.1016/j.mporth.2009.10.003 CrossRefGoogle Scholar
  17. 17.
    Aurégan JC, Bégué T (2014) Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences. Int Orthop 38:1971–1978.  https://doi.org/10.1007/s00264-014-2422-y CrossRefGoogle Scholar
  18. 18.
    Masquelet AC (2017) Induced membrane technique: pearls and pitfalls. J Orthop Trauma 31(Suppl 5):S36–S38.  https://doi.org/10.1097/BOT.0000000000000979 CrossRefGoogle Scholar
  19. 19.
    Metsemakers WJ, Onsea J, Neutjens E, Steffens E, Schuermans A, McNally M, Nijs S (2018) Prevention of fracture-related infection: a multidisciplinary care package. Int Orthop 41(12):2457–2469.  https://doi.org/10.1007/s00264-017-3607-y CrossRefGoogle Scholar
  20. 20.
    Rousset M, Walle M, Cambou L, Mansour M, Samba A, Pereira B, Ghanem I, Canavese F (2018) Chronic infection and infected non-union of the long bones in paediatric patients: preliminary results of bone versus beta-tricalcium phosphate grafting after induced membrane formation. Int Orthop 42(2):385–396.  https://doi.org/10.1007/s00264-017-3693-x CrossRefGoogle Scholar
  21. 21.
    Sasaki G, Watanabe Y, Miyamoto W, Yasui Y, Morimoto S, Kawano H (2018) Induced membrane technique using beta-tricalcium phosphate for reconstruction of femoral and tibial segmental bone loss due to infection: technical tips and preliminary clinical results. Int Orthop 42(1):17–24.  https://doi.org/10.1007/s00264-017-3503-5 CrossRefGoogle Scholar
  22. 22.
    Ronga M, Fagetti A, Canton G, Paiusco E, Surace MF, Cherubino P (2013) Clinical applications of growth factors in bone injuries: experience with BMPs. Injury 44:S34–S39.  https://doi.org/10.1016/S0020-1383(13)70008-1 CrossRefGoogle Scholar
  23. 23.
    Dimitriou R, Mataliotakis GI, Angoules AG, Kanakaris NK, Giannoudis PV (2011) Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury 42:S3–S15.  https://doi.org/10.1016/j.injury.2011.06.015 CrossRefGoogle Scholar
  24. 24.
    Li D, Hu Q, Kang P, Yang J, Zhou Z, Shen B, Pei F (2018) Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft. Int Orthop.  https://doi.org/10.1007/s00264-018-3997-5
  25. 25.
    Giannoudis PV, Einhorn TA, Marsh D (2007) Fracture healing: the diamond concept. Injury 38(Suppl):S3–S6CrossRefGoogle Scholar
  26. 26.
    Dumic-Cule I, Pecina M, Jelic M, Jankolija M, Popek I, Grgurevic L, Vukicevic S (2015) Biological aspects of segmental bone defects management. Int Orthop 39:1005–1011.  https://doi.org/10.1007/s00264-015-2728-4 CrossRefGoogle Scholar
  27. 27.
    Govender S, Csimma C, Genant HK et al (2002) Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients. J Bone Joint Surg Am 84-A(12):2123–2134CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Medicine and Health Sciences ‘Vincenzo Tiberio’University of MoliseCampobassoItaly
  2. 2.Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV)University of InsubriaVareseItaly
  3. 3.Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences (DBSV)University of InsubriaVareseItaly
  4. 4.Department of Orthopedics and TraumatologyUniversity of PaviaPaviaItaly

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