The induced membrane technique for the management of long bone defects

Aims The purpose of this study was to: review the efficacy of the induced membrane technique (IMT), also known as the Masquelet technique; and investigate the relationship between patient factors and technique variations on the outcomes of the IMT. Methods A systematic search was performed in CINAHL, The Cochrane Library, Embase, Ovid MEDLINE, and PubMed. We included articles from 1 January 1980 to 30 September 2019. Studies with a minimum sample size of five cases, where the IMT was performed primarily in adult patients (≥ 18 years old), in a long bone were included. Multivariate regression models were performed on patient-level data to determine variables associated with nonunion, postoperative infection, and the need for additional procedures. Results A total of 48 studies were included, with 1,386 cases treated with the IMT. Patients had a mean age of 40.7 years (4 to 88), and the mean defect size was 5.9 cm (0.5 to 26). In total, 82.3% of cases achieved union after the index second stage procedure. The mean time to union was 6.6 months (1.4 to 58.7) after the second stage. Our multivariate analysis of 450 individual patients showed that the odds of developing a nonunion were significantly increased in those with preoperative infection. Patients with tibial defects, and those with larger defects, were at significantly higher odds of developing a postoperative infection. Our analysis also demonstrated a trend towards the inclusion of antibiotics in the cement spacer having a protective effect against the need for additional procedures. Conclusion The IMT is an effective management strategy for complex segmental bone defects. Standardized reporting of individual patient data or larger prospective trials is required to determine the optimal implementation of this technique. This is the most comprehensive review of the IMT, and the first to compile individual patient data and use regression models to determine predictors of outcomes. Cite this article: Bone Joint J 2020;102-B(12):1723–1734.

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Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes

Injury ◽

10.1016/s0020-1383(16)30840-3 ◽

2016 ◽

Vol 47 ◽

pp. S53-S61 ◽

Cited By ~ 60

Author(s):

Peter V. Giannoudis ◽

Paul J. Harwood ◽

Theodoros Tosounidis ◽

Nikolaos K. Kanakaris

Keyword(s):

Bone Defects ◽

Long Bone ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique

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The Induced Membrane Technique for the Management of Segmental Tibial Defect or Nonunion: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2020/5893642 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Chen-An Hsu ◽

Shih-Heng Chen ◽

Soa-Yu Chan ◽

Yi-Hsun Yu

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Postoperative Infection ◽

Meta Analysis ◽

Union Rate ◽

Infected Nonunion ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique ◽

The Mean

Purpose. To identify the predicting factors for union and infection after applying the induced membrane technique (IMT) for segmental tibial defects. Methods. A systematic review was carried out following the PRISMA guidelines. All databases were searched for articles published between January 2000 and February 2018 using the keywords “Masquelet technique” and “induced membrane technique.” Studies in English reporting more than 5 cases with accessible individual patient data were included. A meta-analysis was performed. Odds ratios (OR) with 95% confidence intervals were calculated. Results. After reviewing, 11/243 studies (115 patients) were finally selected. The mean age of the patients was 43.6 years (range: 18-84 years), and the mean length of the tibial defect was 5.5 cm (range: 0-20 cm). The multivariate logistic regression analysis revealed that the risk factors of postoperative infection after IMT were infected nonunion (p=0.0160) and defect length ≥7 cm (p=0.0291). Patients with postoperative infection after IMT had a lower union rate (p=0.0003). Additionally, the use of an antibiotic polymethyl methacrylate cement spacer reduced the need for surgical revision (p=0.0127). Multiple logistic regression indicated no direct association between the union rate and length of the bone defect. Conclusions. IMT is a reliable and reproducible treatment for segmental tibial defects. However, initial infected nonunion and defect length greater than 7 cm are risk factors for post-IMT infection, and post-IMT infection was statistically related to nonunion.

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Induced membrane technique using enriched bone grafts for treatment of posttraumatic segmental long bone defects

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-019-0522-6 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 5

Author(s):

F. Piacentini ◽

M. J. Ceglia ◽

L. Bettini ◽

S. Bianco ◽

R. Buzzi ◽

...

Keyword(s):

Bone Grafts ◽

Bone Defects ◽

Long Bone ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique

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An Analysis of Complications and Bone Defect Length With the Use of Induced Membrane Technique in the Upper Limb: A Systematic Review

Hand ◽

10.1177/1558944720918368 ◽

2020 ◽

pp. 155894472091836

Author(s):

Casey M. O’Connor ◽

Eric Perloff ◽

James Drinane ◽

Keegan Cole ◽

Patrick G. Marinello

Keyword(s):

Systematic Review ◽

Upper Extremity ◽

Bone Defect ◽

English Language ◽

Bone Defects ◽

Long Bone ◽

Complication Rates ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique

Background: The induced membrane technique was originally described as a technique for the reconstruction of long bone defects. The authors performed a systematic review to determine whether the use of the induced membrane technique is effective in large bony defects in the upper extremity. Methods: A qualitative systematic review was conducted using PubMed, EBSCO, and Google Scholar databases to record all studies reporting on complications of the induced membrane technique in the upper extremity. Studies written after 1990 in English language journals met the inclusion criteria. Exclusion criteria were non-English language publications, animal studies, failure to identify the location of the bone defect, failure to identify whether complications were associated with the procedure, and failure to define the length of bone defect. Results: A total of 1422 studies were identified in the original search. Twelve studies satisfied the criteria for inclusion. A total of 70 patients with 83 upper extremity cases were reported: 1 proximal interphalangeal joint, 22 phalanges, 8 metacarpals, 37 forearms, 14 humeri, and 1 clavicle. The mean bone defect size was 4.0 cm (SD, 1.5). The most common complication was infection. We found that complication rates were independent of the location of the bone defect. Complication rates in the upper extremity ranged from 0% to 100%, with a total weighted mean of 10%. Conclusion: The induced membrane technique is an emerging possible treatment of large bone defects in the upper extremity. More research is needed to determine the outcomes of the induced membrane technique in the upper extremity.

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