The Induced Membrane Technique for Bone Defects: Basic Science, Clinical Evidence, and Technical Tips

Overview

Journal OTA Int

Date 2023 Aug 23

PMID 37608856

Authors

Graeme Hoit

Michael S Kain

Jeremy W Sparkman

Brent L Norris

Janet D Conway

J Tracy Watson

Paul Tornetta 3rd

Aaron Nauth

Affiliations

Soon will be listed here.

Abstract

The clinical management of large bone defects continues to be a difficult clinical problem to manage for treating surgeons. The induced membrane technique is a commonly employed strategy to manage these complex injuries and achieve bone union. Basic science and clinical evidence continue to expand to address questions related to the biology of the membrane and how interventions may impact clinical outcomes. In this review, we discuss the basic science and clinical evidence for the induced membrane technique as well as provide indications for the procedure and technical tips for performing the induced membrane technique.

Citing Articles

Management of Infected Segmental Bone Defects with Antibiotic-Cement-Coated Nails in the First Stage of the Masquelet Technique. Implantation and Removal of the Cement Spacer around the Nail: A Technical Note.

Garabano G, Viollaz G, Pesciallo C Arch Bone Jt Surg. 2024; 12(9):665-668.

PMID: 39498217 PMC: 11531762. DOI: 10.22038/ABJS.2024.72941.3383.

Unique Case of Accelerated Bone Growth Precipitating a One-Stage Masquelet: A Case Report.

Tersteeg M, Simon K, Pruthi S, Hill R, Nahal C, Revak T J Orthop Case Rep. 2024; 14(5):94-98.

PMID: 38784867 PMC: 11111230. DOI: 10.13107/jocr.2024.v14.i05.4446.

In situ forming biomaterials as muscle void fillers for the provisional treatment of volumetric muscle loss injuries.

Clark A, Kulwatno J, Kanovka S, McKinley T, Potter B, Goldman S Mater Today Bio. 2023; 22:100781.

PMID: 37736246 PMC: 10509707. DOI: 10.1016/j.mtbio.2023.100781.

References

Pelissier P, Masquelet A, Bareille R, Pelissier S, Amedee J . Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res. 2003; 22(1):73-9. DOI: 10.1016/S0736-0266(03)00165-7. View

Sanders D, Bhandari M, Guyatt G, Heels-Ansdell D, Schemitsch E, Swiontkowski M . Critical-sized defect in the tibia: is it critical? Results from the SPRINT trial. J Orthop Trauma. 2014; 28(11):632-5. DOI: 10.1097/BOT.0000000000000194. View

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

Yee M, Mead M, Alford A, Hak D, Mauffrey C, Hake M . Scientific Understanding of the Induced Membrane Technique: Current Status and Future Directions. J Orthop Trauma. 2017; 31 Suppl 5:S3-S8. DOI: 10.1097/BOT.0000000000000981. View

Gouron R, Petit L, Boudot C, Six I, Brazier M, Kamel S . Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique. J Tissue Eng Regen Med. 2014; 11(2):382-389. DOI: 10.1002/term.1921. View

Aho O, Lehenkari P, Ristiniemi J, Lehtonen S, Risteli J, Leskela H . The mechanism of action of induced membranes in bone repair. J Bone Joint Surg Am. 2013; 95(7):597-604. DOI: 10.2106/JBJS.L.00310. View

Haines N, Lack W, Seymour R, Bosse M . Defining the Lower Limit of a "Critical Bone Defect" in Open Diaphyseal Tibial Fractures. J Orthop Trauma. 2016; 30(5):e158-63. DOI: 10.1097/BOT.0000000000000531. View

Danino A, Gras M, Coeugniet E, Jebrane A, Harris P . [Is muscle the best coverage for leg Gustilo IIIb fractures? A retrospective comparative study]. Ann Chir Plast Esthet. 2008; 53(6):473-9. DOI: 10.1016/j.anplas.2008.04.005. View

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

10.

Shah S, Smith B, Tatara A, Molina E, Lee E, Piepergerdes T . Effects of Local Antibiotic Delivery from Porous Space Maintainers on Infection Clearance and Induction of an Osteogenic Membrane in an Infected Bone Defect. Tissue Eng Part A. 2016; 23(3-4):91-100. PMC: 5312600. DOI: 10.1089/ten.TEA.2016.0389. View

11.

Lin Z, Wang J, Lin L, Zhang J, Liu Y, Shuai M . Effects of BMP2 and VEGF165 on the osteogenic differentiation of rat bone marrow-derived mesenchymal stem cells. Exp Ther Med. 2014; 7(3):625-629. PMC: 3919869. DOI: 10.3892/etm.2013.1464. View

12.

Masquelet A . Muscle reconstruction in reconstructive surgery: soft tissue repair and long bone reconstruction. Langenbecks Arch Surg. 2003; 388(5):344-6. DOI: 10.1007/s00423-003-0379-1. View

13.

Wu H, Shen J, Yu X, Fu J, Yu S, Sun D . Two stage management of Cierny-Mader type IV chronic osteomyelitis of the long bones. Injury. 2017; 48(2):511-518. DOI: 10.1016/j.injury.2017.01.007. View

14.

Gruber H, Gettys F, Montijo H, Starman J, Bayoumi E, Nelson K . Genomewide molecular and biologic characterization of biomembrane formation adjacent to a methacrylate spacer in the rat femoral segmental defect model. J Orthop Trauma. 2013; 27(5):290-7. DOI: 10.1097/BOT.0b013e3182691288. View

15.

Gruber H, Ode G, Hoelscher G, Ingram J, Bethea S, Bosse M . Osteogenic, stem cell and molecular characterisation of the human induced membrane from extremity bone defects. Bone Joint Res. 2016; 5(4):106-15. PMC: 5009235. DOI: 10.1302/2046-3758.54.2000483. View

16.

Allende C . Cement spacers with antibiotics for the treatment of posttraumatic infected nonunions and bone defects of the upper extremity. Tech Hand Up Extrem Surg. 2010; 14(4):241-7. DOI: 10.1097/BTH.0b013e3181f42bd3. View

17.

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

18.

Wang J, Yin Q, Gu S, Wu Y, Rui Y . Induced membrane technique in the treatment of infectious bone defect: A clinical analysis. Orthop Traumatol Surg Res. 2019; 105(3):535-539. DOI: 10.1016/j.otsr.2019.01.007. View

19.

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

20.

Nauth A, Lee M, Gardner M, Brinker M, Warner S, Tornetta 3rd P . Principles of Nonunion Management: State of the Art. J Orthop Trauma. 2018; 32 Suppl 1:S52-S57. DOI: 10.1097/BOT.0000000000001122. View