The use of free nonvascularized fibular graft in the induced membrane technique to manage post-traumatic bone defects

  • Barakat El-Alfy
  • Mazen Abulsaad
  • Wail Lotfy Abdelnaby
Original Article • LOWER LIMB - FRACTURES
  • 7 Downloads

Abstract

Purpose

The aim of the present study is to assess the results of free nonvascularized fibular graft in the induced membrane technique to manage bone defects.

Materials and methods

Fifteen patients with segmental skeletal defects were treated by the induced membrane technique using free nonvascularized fibular graft. The ages ranged from 20 to 48 years with an average of 32 years. The cause of the defects was post-traumatic bone loss in all cases. The defects were located in the distal femur in nine cases, proximal tibia in two cases and middle third of the tibia in four cases. The defects ranged from 5 to 14 cm with an average of 8 cm. All cases were treated by the induced membrane technique in two stages. Autogenous cancellous bone graft and free nonvascularized fibular graft were used to fill the defect in the second stage of surgery.

Results

All cases healed without additional procedures after the second stage except in two cases. The time-to-bone union ranged from 4 to 13 months with an average of 7 months. After physiotherapy, all cases regained good range of ankle and knee movements except two cases. The complications included nonunion of the graft in two cases, deep wound infection in one case, and chronic pain along the iliac crest in one case. No cases were complicated by implant failure or refracture.

Conclusion

The use of free nonvascularised fibular graft in the induced membrane technique reduces the time of healing and improves the final outcome.

Keywords

Bone defects Induced membrane technique Fibular bone graft 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no any conflict of interest.

Informed consent

: Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA (2004) Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 12:28–38CrossRefPubMedGoogle Scholar
  2. 2.
    Masquelet AC, Fitoussi F, Begue T, Muller GP (2000) Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet 45:346–353PubMedGoogle Scholar
  3. 3.
    Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41(1):27–37CrossRefPubMedGoogle Scholar
  4. 4.
    Stafford PR, Norris BL(2010) Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: a review of 25 cases. Injury 41 (Suppl 2) S72eS77Google Scholar
  5. 5.
    Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R (2011) Masquelet technique for the treatment of bone defects: tips-tricks and future directions. Injury 42(6):591–598CrossRefPubMedGoogle Scholar
  6. 6.
    Gouron R, Deroussen F, Plancq MC et al (2013) Bone defect reconstruction in children using the induced membrane technique: a series of 14 cases. Orthop Traumatol Surg Res 99(7):837–843CrossRefPubMedGoogle Scholar
  7. 7.
    Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453–458CrossRefPubMedGoogle Scholar
  8. 8.
    Pelissier Ph, Masquelet AC, Bareille R, Pelissier SM, Amedee J (2004) Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 22:73–79CrossRefPubMedGoogle Scholar
  9. 9.
    Viateau V, Guillemin G, Calando Y, Oudina K, Sedel L, Hannouche D, Petite H (2008) Reconstruction de perte de substance osseuse massive par la proc´edure de Masquelet: mod`ele exp´erimental chez la brebis. J Bone Joint Surg Br 90 Supp II 254Google Scholar
  10. 10.
    Cox G, Jones E, McGonagle D, Giannoudis PV (2011) Reamer- rrigator-aspirator indications and clinical results: a systematic review. Int Orthop 35(7):951–956CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Greenwald AS, Boden SD, Goldberg VM et al (2001) Bone-graft substitutes: facts, fictions, and applications. J. Bone Joint Surg Am 83(Suppl 2):98–103CrossRefPubMedGoogle Scholar
  12. 12.
    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. Orthopaed Traumatol Surg Res 96:549–553CrossRefGoogle Scholar
  13. 13.
    Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC, French Society of Orthopaedic Surgery and Traumatology (SoFCOT) (2012) Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 98:97–102CrossRefPubMedGoogle Scholar
  14. 14.
    Taylor BC, French BG, Fowler TT, Russell J, Poka A (2012) Induced membrane technique for reconstruction to manage bone loss. J Am Acad Orthop Surg 20(3):142–150CrossRefPubMedGoogle Scholar
  15. 15.
    El-Alfy BS, Ali AM (2015) Management of segmental skeletal defects by the induced membrane technique. Indian J Orthop 49:643–648CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Mauffrey C, Hake ME, Chadayammuri V et al (2015) Reconstruction of long bone infections using the induced membrane technique: tips and tricks. J Orthop Trauma 30(6):188–193Google Scholar
  17. 17.
    Gouron R (2016) Surgical technique and indications of the induced membrane procedure in children. Orthop Traumatol Surg Res 102:S133–S139CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Barakat El-Alfy
    • 1
  • Mazen Abulsaad
    • 1
  • Wail Lotfy Abdelnaby
    • 1
  1. 1.Department of Orthopedic Surgery, Faculty of MedicineMansoura UniversityMansouraEgypt

Personalised recommendations