Impact of scaffold granule size use in Masquelet technique on periosteal reaction: a study in rat femur critical size bone defect model

Abstract Purpose The Masquelet technique for the treatment of large bone defects is a two-stage procedure based on an induced membrane. Compared to mature periosteum, the induced membrane differs significantly. However, both play a crucial role in bone regeneration. As part of a histological and radiological post-evaluation of an earlier project, we analyzed the influence of the granule size of the bone void filler Herafill® on development of periosteum regrowth in a critical size defect. Methods We compared three different sizes of Herafill® granules (Heraeus Medical GmbH, Wehrheim) in vivo in a rat femoral critical size defect (10 mm) treated with the induced membrane technique. After 8 weeks healing time, femurs were harvested and taken for histological and radiological analysis. Results A significantly increased regrowth of periosteum into the defect was found when small granules were used. Large granules showed significantly increased occurrence of bone capping. Small granules lead to significant increase in callus formation in the vicinity to the membrane. Conclusion The size of Herafill® granules has significant impact on the development of periosteal-like structures around the defect using Masquelet’s induced membrane technique. Small granules show significantly increased regrowth of periosteum and improved bone formation adjacent to the induced membrane.

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The masquelet induced membrane technique with BMP and a synthetic scaffold can heal a rat femoral critical size defect

Journal of Orthopaedic Research® ◽

10.1002/jor.22815 ◽

2015 ◽

Vol 33 (4) ◽

pp. 488-495 ◽

Cited By ~ 46

Author(s):

Per Bosemark ◽

Christina Perdikouri ◽

Mea Pelkonen ◽

Hanna Isaksson ◽

Magnus Tägil

Keyword(s):

Critical Size ◽

Critical Size Defect ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Synthetic Scaffold

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Induced Membrane Technique: Effects of Antbiotic-impregnated Spacers on Healing of a Critical-size Femoral Defect in a Rat Model

OrthoMedia ◽

10.1302/3114-220876 ◽

2022 ◽

Keyword(s):

Rat Model ◽

Critical Size ◽

Induced Membrane ◽

Femoral Defect ◽

Membrane Technique ◽

Induced Membrane Technique

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Radiological and clinical outcomes using induced membrane technique combined with bone marrow concentrate in the treatment of chronic osteomyelitis of immature patients

Bone and Joint Research ◽

10.1302/2046-3758.101.bjr-2020-0229.r1 ◽

2021 ◽

Vol 10 (1) ◽

pp. 31-40

Author(s):

Jie Shen ◽

Dong Sun ◽

Shengpeng Yu ◽

Jingshu Fu ◽

Xiaohua Wang ◽

...

Keyword(s):

Bone Marrow ◽

Bone Healing ◽

Chronic Osteomyelitis ◽

Young Patients ◽

Bone Defects ◽

Healing Time ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Large Bone

Aims Treatment of chronic osteomyelitis (COM) for young patients remains a challenge. Large bone deficiencies secondary to COM can be treated using induced membrane technique (IMT). However, it is unclear which type of bone graft is optimal. The goal of the study was to determine the clinical effectiveness of bone marrow concentrator modified allograft (BMCA) versus bone marrow aspirate mixed allograft (BMAA) for children with COM of long bones. Methods Between January 2013 and December 2017, 26 young patients with COM were enrolled. Different bone grafts were applied to repair bone defects secondary to IMT procedure for infection eradication. Group BMCA was administered BMCA while Group BMAA was given BMAA. The results of this case-control study were retrospectively analyzed. Results Patient infection in both groups was eradicated after IMT surgery. As for reconstruction surgery, no substantial changes in the operative period (p = 0.852), intraoperative blood loss (p = 0.573), or length of hospital stay (p = 0.362) were found between the two groups. All patients were monitored for 12 to 60 months. The median time to bone healing was 4.0 months (interquartile range (IQR) 3.0 to 5.0; range 3 to 7) and 5.0 months (IQR 4.0 to 7.0; range 3 to 10) in Groups BMCA and BMAA, respectively. The time to heal in Group BMCA versus Group BMAA was substantially lower (p = 0.024). Conclusion IMT with BMCA or BMAA may attain healing in large bone defects secondary to COM in children. The bone healing time was significantly shorter for BMCA, indicating that this could be considered as a new strategy for bone defect after COM treatment. Cite this article: Bone Joint Res 2021;10(1):31–40.

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Modified Masquelet Technique Using Allogeneic Graft for a Gustilo-Anderson Type III-A Open Fracture of the Femur with an 8 cm Bone Defect

Case Reports in Orthopedics ◽

10.1155/2021/8829158 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Hichem Issaoui ◽

Mohammed Reda Fekhaoui ◽

Moheddin Jamous ◽

Alain-Charles Masquelet

Keyword(s):

Bone Graft ◽

Bone Defect ◽

Bony Union ◽

Induced Membrane ◽

Masquelet Technique ◽

Membrane Technique ◽

Defect Area ◽

Induced Membrane Technique ◽

Large Bone

The induced membrane technique was initially described by Masquelet et al. in 1986 as a treatment for tibia nonunion; then, it became one of the established methods in the management of bone defects. Several changes have been made to this technique and have been used in different contexts and different methodologies. We present the case of a 16-year-old girl admitted to our department for a polytrauma after a motorcycle accident. She presented a Gustilo III-A open fracture of the right femoral shaft with a large bone defect of 8 centimeters that we treated with a modified Masquelet technique. In the first stage, an Open Reduction and Internal Fixation of the fracture was made using a 4,5 mm Dynamic Compression Plate and a PMMA cement was inserted at the bone defect area. The second stage was done after 11 weeks, and the defect area was filled exclusively with bone allograft from a bone bank. Complete bony union was seen at 60 weeks of follow-up. After the removal of the implants by another surgeon, the patient presented an atraumatic fracture of the neoformed bone that we treated with intramedullary femoral nailing associated with a local autograft using reaming debris. A complete bony union was achieved after 12 weeks with a complete range of motion of the hip and knee. The stability given to the fracture is essential because it influences the quality of the induced membrane and Masquelet has recommended high initial fixation rigidity to promote incorporation of the graft. It is recommended to delay the second stage of this technique after 8 weeks, especially in femoral reconstruction, to optimize the quality of the induced membrane. Several studies used a modified induced membrane technique to recreate a traumatic large bone defect, and all of them used an autologous bone graft alone or an enriched bone graft. In this case, the use of allograft exclusively seems to be as successful as an autologous or enriched bone graft. Now, with the advent of bone banks, it is possible to get an unlimited amount of allograft, so additional research and large studies are necessary before giving recommendations.

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