Induced Membrane Technique for the Treatment of Severe Acute Tibial Bone Loss: Preliminary Experience at Medium-term Follow-up

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2018 Oct 4

PMID 30280216

Citations 20

Authors

Mario Ronga

Mario Cherubino

Katia Corona

Alessandro Fagetti

Barbara Bertani

Luigi Valdatta

Redento Mora

Paolo Cherubino

Affiliations

Soon will be listed here.

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.

Citing Articles

Application of double plate fixation combined with Masquelet technique for large segmental bone defects of distal tibia: a retrospective study and literature review.

Wang Z, Zou C, Zhan X, Li X, Ghen G, Gao J BMC Surg. 2024; 24(1):103.

PMID: 38600472 PMC: 11007926. DOI: 10.1186/s12893-024-02396-1.

Regulation of the integrin αVβ3- actin filaments axis in early osteogenic differentiation of human mesenchymal stem cells under cyclic tensile stress.

Peng Y, Qu R, Yang Y, Fan T, Sun B, Khan A Cell Commun Signal. 2023; 21(1):308.

PMID: 37904190 PMC: 10614380. DOI: 10.1186/s12964-022-01027-7.

A modified hybrid transport technique combined with a retrograde tibiotalocalcaneal arthrodesis nail for the management of distal tibial periarticular osteomyelitis and associated defects.

Wang C, Ma T, Li Z, Wang Q, Li Z, Zhang K J Orthop Surg Res. 2023; 18(1):259.

PMID: 36991442 PMC: 10061873. DOI: 10.1186/s13018-023-03744-2.

Proximal versus distal bone transport for the management of large segmental tibial defect: a clinical case series.

Lu Y, Wang Q, Ren C, Li M, Li Z, Zhang K Sci Rep. 2023; 13(1):3883.

PMID: 36890222 PMC: 9995462. DOI: 10.1038/s41598-023-31098-6.

Is immediate internal fixation safe in induced membrane technique?.

Akan I, Bacaksiz T, Ozpolat N, Tuncez M, Kazimoglu C Jt Dis Relat Surg. 2023; 34(1):151-157.

PMID: 36700277 PMC: 9903124. DOI: 10.52312/jdrs.2023.829.

References

Masquelet A, Begue T . The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am. 2009; 41(1):27-37. DOI: 10.1016/j.ocl.2009.07.011. View

El-Gammal T, Shiha A, El-Deen M, El-Sayed A, Kotb M, Addosooki A . Management of traumatic tibial defects using free vascularized fibula or Ilizarov bone transport: a comparative study. Microsurgery. 2008; 28(5):339-46. DOI: 10.1002/micr.20501. View

Govender S, Csimma C, Genant H, Valentin-Opran A, Amit Y, Arbel R . 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. 2002; 84(12):2123-34. DOI: 10.2106/00004623-200212000-00001. View

Li D, Hu Q, Kang P, Yang J, Zhou Z, Shen B . Reconstructed the bone stock after femoral bone loss in Vancouver B3 periprosthetic femoral fractures using cortical strut allograft and impacted cancellous allograft. Int Orthop. 2018; 42(12):2787-2795. DOI: 10.1007/s00264-018-3997-5. View

Dimitriou R, Mataliotakis G, Angoules A, Kanakaris N, Giannoudis P . Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review. Injury. 2011; 42 Suppl 2:S3-15. DOI: 10.1016/j.injury.2011.06.015. View

Masquelet A . Induced Membrane Technique: Pearls and Pitfalls. J Orthop Trauma. 2017; 31 Suppl 5:S36-S38. DOI: 10.1097/BOT.0000000000000979. View

Sasaki G, Watanabe Y, Miyamoto W, Yasui Y, Morimoto S, Kawano H . 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. 2017; 42(1):17-24. DOI: 10.1007/s00264-017-3503-5. View

Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet A . Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res. 2012; 98(1):97-102. DOI: 10.1016/j.otsr.2011.11.001. View

Molina C, Stinner D, Obremskey W . Treatment of Traumatic Segmental Long-Bone Defects: A Critical Analysis Review. JBJS Rev. 2016; 2(4). DOI: 10.2106/JBJS.RVW.M.00062. View

10.

Dumic-cule I, Pecina M, Jelic M, Jankolija M, Popek I, Grgurevic L . Biological aspects of segmental bone defects management. Int Orthop. 2015; 39(5):1005-11. DOI: 10.1007/s00264-015-2728-4. View

11.

Ronga M, Fagetti A, Canton G, Paiusco E, Surace M, Cherubino P . Clinical applications of growth factors in bone injuries: experience with BMPs. Injury. 2013; 44 Suppl 1:S34-9. DOI: 10.1016/S0020-1383(13)70008-1. View

12.

Taylor B, Hancock J, Zitzke R, Castaneda J . Treatment of Bone Loss With the Induced Membrane Technique: Techniques and Outcomes. J Orthop Trauma. 2015; 29(12):554-7. DOI: 10.1097/BOT.0000000000000338. View

13.

Muhlhausser J, Winkler J, Babst R, Beeres F . Infected tibia defect fractures treated with the Masquelet technique. Medicine (Baltimore). 2017; 96(20):e6948. PMC: 5440151. DOI: 10.1097/MD.0000000000006948. View

14.

Azi M, Teixeira A, Cotias R, Joeris A, Kfuri Jr M . Membrane Induced Osteogenesis in the Management of Posttraumatic Bone Defects. J Orthop Trauma. 2016; 30(10):545-550. DOI: 10.1097/BOT.0000000000000614. View

15.

Auregan J, Begue T . Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences. Int Orthop. 2014; 38(9):1971-8. DOI: 10.1007/s00264-014-2422-y. View

16.

Masquelet A, Fitoussi F, Begue T, Muller G . [Reconstruction of the long bones by the induced membrane and spongy autograft]. Ann Chir Plast Esthet. 2000; 45(3):346-53. View

17.

Giannoudis P, Einhorn T, Marsh D . Fracture healing: the diamond concept. Injury. 2008; 38 Suppl 4:S3-6. DOI: 10.1016/s0020-1383(08)70003-2. View

18.

Ronga M, Ferraro S, Fagetti A, Cherubino M, Valdatta L, Cherubino P . Masquelet technique for the treatment of a severe acute tibial bone loss. Injury. 2014; 45 Suppl 6:S111-5. DOI: 10.1016/j.injury.2014.10.033. View

19.

Giannoudis P, Harwood P, Tosounidis T, Kanakaris N . Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes. Injury. 2017; 47 Suppl 6:S53-S61. DOI: 10.1016/S0020-1383(16)30840-3. View

20.

Morelli I, Drago L, George D, Gallazzi E, Scarponi S, Romano C . Masquelet technique: myth or reality? A systematic review and meta-analysis. Injury. 2017; 47 Suppl 6:S68-S76. DOI: 10.1016/S0020-1383(16)30842-7. View