Abstract
Background
Gap nonunion of long bones is a challenging problem, due to the limitation of conventional reconstructive techniques more so if associated with infection and soft tissue defect. Treatment options such as autograft with non-vascularized fibula and cancellous bone graft, vascularized bone graft, and bone transportation are highly demanding on the part of surgeons and hospital setups and have many drawbacks. This study aims to analyze the outcome of patients with wide diaphyseal bone gap treated with induced-membrane technique (Masquelet technique).
Materials and Methods
This study included 9 patients (7 males and 2 females), all with tibial bone-gap. Eight of the 9 patients were infected and in 3 patients there was associated large soft tissue defect requiring flap cover. This technique is two-stage procedure. Stage I surgery included debridement, fracture stabilization, application of spacer between bone ends, and soft tissue reconstruction. Stage II surgery included removal of spacer with preservation of induced membrane formed at spacer surface and filling the bone-gap with morselized iliac crest bone-graft within the membrane sleeve. Average bone-gap of 5.2 cm was treated. The spacer was always found to be encapsulated by a thick glistening membrane which did not collapse after its removal. All patients were followed up for an average period of 21.5 months.
Results
Serial Radiographs showed regular uptake of autograft and thus consolidation within themselves in the region of bone gap and also with host bone. Bone-union was documented in all patients and all patients are walking full weight-bearing without support.
Conclusions
The study highlights that the technique provide effective and practical management for difficult gap nonunion. It does not require specialized equipment, investigations, and surgery. Thus, it provides a reasonable alternative to the developing infrastructures and is a reliable and reproducible technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Trivedi A, Rawal D. Prevalence of road traffic accidents and driving practices among young drivers. Health Line 2011;2:72–5.
Steinlechner CW, Mkandawire NC. Non-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children. J Bone Joint Surg Br 2005;87:1259–63.
Nusbickel FR, Dell PC, McAndrew MP, Moore MM. Vascularized autografts for reconstruction of skeletal defects following lower extremity trauma. A review. Clin Orthop Relat Res 1989;243:65–70.
Aronson J. Limb-lengthening, skeletal reconstruction, and bone transport with the Ilizarov method. J Bone Joint Surg Am 1997;79:1243–58.
Giannikas KA, Maganaris CN, Karski MT, Twigg P, Wilkes RA, Buckley JG. Functional outcome following bone transport reconstruction of distal tibial defects. J Bone Joint Surg Am 2005;87:145–52.
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.
Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 1975;55:533–44.
Vail TP, Urbaniak JR. Donor-site morbidity with use of vascularized autogenous fibular grafts. J Bone Joint Surg Am 1996;78:204–11.
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.
Roche O, Zabée L, Sirveaux F, Villanueva E, Molé D. Treatment of septic nonunion of long bones: Preliminary results of a two-stage procedure. J Bone Joint Surg Br 2005;87 Supp II:111–2.
Huffman LK, Harris JG, Suk M. Using the bi-masquelet technique and reamer-irrigator-aspirator for post traumatic foot reconstruction. Foot Ankle Int 2009;30:895–9.
Biau DJ, Pannier S, Masquelet AC, Glorion C. Case report: Reconstruction of a 16-cm diaphyseal defect after Ewing’s resection in a child. Clin Orthop Relat Res 2009;467:572–7.
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 post traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res 2010;96:549–53.
Jones AL, Bucholz RW, Bosse MJ, Mirza SK, Lyon TR, Webb LX, et al. Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects. A randomized, controlled trial. J Bone Joint Surg Am 2006;88:1431–41.
McCall TA, Brokaw DS, Jelen BA, Scheid DK, Scharfenberger AV, Maar DC, et al. Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: Technique and case series. Orthop Clin North Am 2010;41:63–73.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gupta, G., Ahmad, S., Zahid, M. et al. Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”. IJOO 50, 290–296 (2016). https://doi.org/10.4103/0019-5413.181780
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.181780