Circumferential bone grafting around an absorbable gelatin sponge core reduced the amount of grafted bone in the induced membrane technique for critical-size defects of long bones

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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Augmented plate causes bone resorption in reconstruction of large segmental femur defects with induced membrane technique

10.21203/rs.3.rs-46812/v1 ◽

2020 ◽

Author(s):

Shengpeng Yu ◽

Bao Yin ◽

Shulin Wang ◽

Chao Jia ◽

Shu Li ◽

...

Keyword(s):

Bone Resorption ◽

Bone Grafting ◽

Bone Union ◽

Fixation Method ◽

Induced Membrane ◽

Second Stage ◽

Plate Group ◽

Membrane Technique ◽

New Findings ◽

Induced Membrane Technique

Abstract Purposes: Large segmental femur bone defect is a serious clinical problem. Limited study have been reported to optimize the fixation during the second stage of induced membrane technique. We would like to report our new findings in two different fixation method with this technique. Methods: We retrospectively analyzed 56 cases with large segmental femur defects and treated with induced membrane technique from January 2013 to December 2017. Patients were separated into two groups according to different fixation method during the second stage and followed at least 2 years. Bacteria culture, treatment outcome, and complication were collected and analysed. Results: Patients with an average age of 41.8 years old had an average of 2.6 surgical history. Bone defects were 8.93 cm in average ( 4-16.8 cm). Though 20 complications were noticed in this series, 85.7% (48/56) of the cases acquired bone union during their final follow up. However, 57.6%(15/26) of the cases observed obvious bone resorption near the plate in augmented plate group. And this resulted to lower bone union rate was calculated when compared with intramedullary nail group (P = 0.019). Insufficient bone grafting material is another main reason resulted nonunion and verified in 5 cases. Conclusions: Augmented plate will resulted bone resorption and leads to nonunion in induced membrane technique. The plate should be fixated outside the membrane if necessary. Insufficient bone grafting material when grafting is a easily neglectful problem, and proper measures should be taken with cautious.

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