Skip to main content
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 6/2018

14.02.2018 | Original Article • LOWER LIMB - FRACTURES

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

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 6/2018

Einloggen, um Zugang zu erhalten

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.
Literatur
1.
Zurück zum Zitat DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA (2004) Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 12:28–38CrossRefPubMed DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA (2004) Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 12:28–38CrossRefPubMed
2.
Zurück zum Zitat 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 45:346–353PubMed 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 45:346–353PubMed
3.
Zurück zum Zitat Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41(1):27–37CrossRefPubMed Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41(1):27–37CrossRefPubMed
4.
Zurück zum Zitat 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) S72eS77 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) S72eS77
5.
Zurück zum Zitat 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):591–598CrossRefPubMed 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):591–598CrossRefPubMed
6.
Zurück zum Zitat 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):837–843CrossRefPubMed 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):837–843CrossRefPubMed
7.
Zurück zum Zitat 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 58:453–458CrossRefPubMed 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 58:453–458CrossRefPubMed
8.
Zurück zum Zitat 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 22:73–79CrossRefPubMed 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 22:73–79CrossRefPubMed
9.
Zurück zum Zitat 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 254 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 254
10.
Zurück zum Zitat Cox G, Jones E, McGonagle D, Giannoudis PV (2011) Reamer- rrigator-aspirator indications and clinical results: a systematic review. Int Orthop 35(7):951–956CrossRefPubMedPubMedCentral Cox G, Jones E, McGonagle D, Giannoudis PV (2011) Reamer- rrigator-aspirator indications and clinical results: a systematic review. Int Orthop 35(7):951–956CrossRefPubMedPubMedCentral
11.
Zurück zum Zitat Greenwald AS, Boden SD, Goldberg VM et al (2001) Bone-graft substitutes: facts, fictions, and applications. J. Bone Joint Surg Am 83(Suppl 2):98–103CrossRefPubMed Greenwald AS, Boden SD, Goldberg VM et al (2001) Bone-graft substitutes: facts, fictions, and applications. J. Bone Joint Surg Am 83(Suppl 2):98–103CrossRefPubMed
12.
Zurück zum Zitat 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 96:549–553CrossRef 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 96:549–553CrossRef
13.
Zurück zum Zitat 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 98:97–102CrossRefPubMed 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 98:97–102CrossRefPubMed
14.
Zurück zum Zitat 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):142–150CrossRefPubMed 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):142–150CrossRefPubMed
16.
Zurück zum Zitat 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):188–193 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):188–193
17.
Zurück zum Zitat Gouron R (2016) Surgical technique and indications of the induced membrane procedure in children. Orthop Traumatol Surg Res 102:S133–S139CrossRefPubMed Gouron R (2016) Surgical technique and indications of the induced membrane procedure in children. Orthop Traumatol Surg Res 102:S133–S139CrossRefPubMed
Metadaten
Titel
The use of free nonvascularized fibular graft in the induced membrane technique to manage post-traumatic bone defects
Publikationsdatum
14.02.2018
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 6/2018
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-018-2153-7

Weitere Artikel der Ausgabe 6/2018

European Journal of Orthopaedic Surgery & Traumatology 6/2018 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.