Clinical and radiological assessment of the induced membrane technique using beta-tricalcium phosphate in reconstructive surgery for lower extremity long bone defects

2021 ◽  
Vol 103-B (3) ◽  
pp. 456-461
Author(s):  
Gen Sasaki ◽  
Yoshinobu Watanabe ◽  
Youichi Yasui ◽  
Mari Nishizawa ◽  
Natsumi Saka ◽  
...  
Keyword(s):  
Bone Healing ◽  
Bone Defects ◽  
Defect Size ◽  
Lower Limbs ◽  
Second Stage ◽  
Beta Tricalcium Phosphate ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
Segmental Bone

Aims To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (β-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. Methods A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using β-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. Results There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. Conclusion IMT using β-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456–461.

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

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.

The induced membrane technique for the management of long bone defects

2020 ◽  
Vol 102-B (12) ◽  
pp. 1723-1734
Author(s):  
Benjamin Fung ◽  
Graeme Hoit ◽  
Emil Schemitsch ◽  
Charles Godbout ◽  
Aaron Nauth
Keyword(s):  
Regression Models ◽  
Postoperative Infection ◽  
Individual Patient Data ◽  
Bone Defects ◽  
Long Bone ◽  
Induced Membrane ◽  
Second Stage ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
The Mean

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.

scholarly journals Analysis of the early therapeutic effects and healing outcomes of segmental bone defects in the ankle joint treated with the induced membrane/wrapped bone grafting technique

2020 ◽  
Author(s):  
Wenbin Zhao ◽  
Maopeng Wang ◽  
Xingshi Lin ◽  
Feng Tu ◽  
Dongfeng Zhao
Keyword(s):  
Body Temperature ◽  
Bone Cement ◽  
Ankle Joint ◽  
Bone Defects ◽  
Micro Ct ◽  
Induced Membrane ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
Segmental Bone ◽  
Segmental Bone Defects

Abstract BackgroundThe current research explores the early therapeutic efficacy and healing outcomes of segmental bone defects in the ankle joint treated with induced membrane technique. MethodsA segmental bone defect model of ankle joint was first constructed by removing 2mm bone from the ankle joint of the rat, and then the induced membrane treatment was performed in two steps: the first step was to implant polymethyl methacrylate bone cement after thorough debridement, followed by the second step to remove bone cement after membrane formation and to replace with the rat’s autologous cancellous bone. The physiological indicators (body temperature and body weight) of the rats and the TNF-α and CRP in the blood were monitored post-surgery, and the efficacy was analyzed based on the above combining Micro-CT and X-ray analysis. Postoperative histological analysis of the tissue morphology of partial induced membrane was performed in rats at 2, 4, 6, and 8 weeks to evaluate the tissue status at the sites of bone defect. ResultsResults showed that the rats survived well after operation: the body temperature slowly decreased, and the CRP was also gradually reduced to normal; the 12-week Micro-CT and palpation indicated a satisfying bone healing trend; histological studies found calcified tissue in the second week post-operation, and vascular network was established in the induced sites at 8 weeks.ConclusionThe study proves that the induced membrane technique can effectively treat segmental bone defects of ankle joint, and is less prone to infection.

scholarly journals Artificial Membrane Induced by Novel Biodegradable Nanofibers in the Masquelet Procedure for Treatment of Segmental Bone Defects

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Yi-Hsun Yu ◽  
Ren-Chin Wu ◽  
Demei Lee ◽  
Che-Kang Chen ◽  
Shih-Jung Liu
Keyword(s):  
Bone Graft ◽  
Bone Defects ◽  
Artificial Membrane ◽  
Union Rate ◽  
Segmental Bone Defect ◽  
Additional Surgery ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
Segmental Bone ◽  
Segmental Bone Defects

The Masquelet induced-membrane technique for the treatment of segmental bone defects includes a two-stage surgical procedure, and polymethylmethacrylate (PMMA) plays a major role in the treatment. However, the PMMA spacer must be surgically removed. Here, we investigated the potential of poly(lactic-co-glycolic acid) (PLGA) nanofibers, a biodegradable material to replace the PMMA spacer, allowing the bioactive membrane to be induced and the spacer to degrade without the additional surgery on a rabbit femoral segmental bone defect model. PLGA nanofibers were shown to degrade completely six weeks after implantation in the investigated animals, and a thick membrane was found to circumferentially fold around the segmental bone defects. Results from image studies demonstrated that, in the group without the bone graft, all studied femurs exhibited either nonunion or considerable malunion. In contrast, the femurs in the bone graft group had a high union rate without considerable deformities. Histological examinations suggested that the membranous tissue in this group was rich in small blood vessels and the expression of BMP2 and VEGF increased. Our results demonstrate that the biodegradable PLGA nanofibers may be useful for replacing the PMMA spacer as the bioactive-membrane inducer, facilitating the process of healing and removing the need for repeated surgeries.

Locking Compression Plate as an External Fixator for the Treatment of Tibia Infected Bone Defects

2021 ◽  
Author(s):  
Hong Xiao ◽  
Shulin Wang ◽  
Feibo Wang ◽  
Sun Dong ◽  
Jie Shen ◽  
...  
Keyword(s):  
External Fixator ◽  
Bone Defects ◽  
Locking Compression Plate ◽  
External Fixators ◽  
Induced Membrane ◽  
Locking Compression Plates ◽  
Membrane Technique ◽  
Compression Plate ◽  
Induced Membrane Technique

Abstract Purpose This study was designed to observe the medium-term efficacy of an induced membrane technique combined with a locking compression plate as an external fixator for the treatment of tibia infected bone defects. Methods Patients with a tibial infection were admitted to our department between January 2013 and November 2014. All patients were treated with the induced membrane technique. In the first stage, polymethyl methacrylate (PMMA) cement was implanted in the defects after debridement and then fixed with a locking compression plate (LCP) as an external fixator. In the second stage, bone grafts were implanted to rebuild the defects. The external plates were replaced with nails in 57 patients (internal group), and the remaining 30 patients were not exchanged with fixation (external group). The infection control rate, bone union rate, and complications of the two groups were compared. Results Eighty-seven patients were enrolled in this study, and all patients had a minimum follow-up of 5 years (average 62.8 months) after grafting. Eighty-three patients (95.4%) achieved bone union, and the average union time was 6.77 months. Five patients (5.7%) experienced recurrence of infection. Complications included pin tract infection, fixation loosening, deformity connection, and limitation of joint range of motion (ROM). No significant differences in the infection control rate or bone defect union rate were noted between the two groups. The overall rate of complications in the external group was 50%, which was greater than that noted in the internal group (21.1%). Conclusions Locking compression plates are external fixators with smaller sizes that are easier to operate than conventional annular fixators or assembled external fixators. The use of locking compression plates in combination with the induced membrane technique in the treatment of tibia infected bone defects can achieve good clinical efficacy after medium-term follow-up.

Artificial Membrane Induced by Novel Biodegradable Nanofibrous Scaffold in the Masquelet Procedure for the Treatment of Segmental Bone Defects

2018 ◽  
Author(s):  
Yi-Hsun Yu ◽  
Ren-Chin Wu ◽  
Demei Lee ◽  
Che-Kang Chen ◽  
Shih-Jung Liu
Keyword(s):  
Bone Graft ◽  
Bone Defects ◽  
Artificial Membrane ◽  
Segmental Bone Defect ◽  
Additional Surgery ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
Segmental Bone ◽  
Without Bone Graft ◽  
Segmental Bone Defects

Masquelet induced-membrane technique for the treatment of segmental bone defects includes a two-stage surgical procedure, and polymethylmethacrylate (PMMA) plays a major role in the treatment. However, the PMMA spacer must be surgically removed. Here, we investigated the potential of poly (lactic-co-glycolic acid) (PLGA) nanofibers, a biodegradable material to replace PMMA spacer, allowing the bioactive membrane to be induced, and the spacer to degrade without the additional surgery on a rabbit femoral segmental bone defect model. PLGA nanofibers were shown to degrade completely six weeks after implantation in the investigated animals, and a thick membrane was found to circumferentially fold around the segmental bone defects. Results from image studies demonstrated that, in the group without bone graft, all studied femurs exhibited either nonunion or considerable malunion. In contrast, the femurs in the bone graft group had a high union rate without considerable deformities. Histological examinations suggested that the membranous tissue in this group was rich in small blood vessels and the expression of BMP2 and VEGF increased. Our results demonstrate that the biodegradable PLGA nanofibers may be useful for replacing the PMMA spacer as the bioactive-membrane inducer, facilitating the process of healing and removing the need for repeated surgeries.

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