Bone-Graft Resorption Reduced by the Induced Membrane Technique and Factors Affecting Volumetric Changes

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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Similarities and Differences of Induced Membrane Technique Versus Wrap Bone Graft Technique

Indian Journal of Orthopaedics ◽

10.1007/s43465-019-00006-4 ◽

2020 ◽

Vol 54 (2) ◽

pp. 156-163

Author(s):

Yongwei Wu ◽

Qudong Yin ◽

Zihong Zhou ◽

Sanjun Gu ◽

Yongjun Rui ◽

...

Keyword(s):

Bone Graft ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Similarities And Differences

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Role of beta tri-calcium phosphate-based composite ceramic as bone-graft expander in Masquelet's-induced membrane technique

Indian Journal of Orthopaedics ◽

10.4103/ortho.ijortho_240_17 ◽

2019 ◽

Vol 53 (1) ◽

pp. 63 ◽

Cited By ~ 2

Author(s):

Sandeep Gupta ◽

Anubhav Malhotra ◽

Rohit Jindal ◽

SudhirKumar Garg ◽

Rajeev Kansay ◽

...

Keyword(s):

Calcium Phosphate ◽

Bone Graft ◽

Composite Ceramic ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique

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Pedicled Vascularized Bone Graft Versus Induced Membrane Technique for Reconstruction of Forearm Medium-Size Bone Defects

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2018.06.094 ◽

2018 ◽

Vol 43 (9) ◽

pp. S45-S46

Author(s):

Ezequiel Ernesto Zaidenberg ◽

Timothy Paul Dooley ◽

Carlos Rodolfo Zaidenberg

Keyword(s):

Bone Graft ◽

Bone Defects ◽

Medium Size ◽

Vascularized Bone Graft ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Vascularized Bone

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Total Flavonoids of Rhizoma Drynariae Promotes Differentiation of Osteoblasts and Growth of Bone Graft in Induced Membrane Partly by Activating Wnt/β-Catenin Signaling Pathway

Frontiers in Pharmacology ◽

10.3389/fphar.2021.675470 ◽

2021 ◽

Vol 12 ◽

Author(s):

Shuyuan Li ◽

Hongliang Zhou ◽

Cheng Hu ◽

Jiabao Yang ◽

Jinfei Ye ◽

...

Keyword(s):

Western Blot ◽

Bone Graft ◽

Signaling Pathway ◽

Bone Defect ◽

Dose Group ◽

Total Flavonoids ◽

Induced Membrane ◽

Membrane Technique ◽

Induced Membrane Technique ◽

Rhizoma Drynariae

Total flavonoids of Rhizoma drynariae (TFRD), a Chinese medicine, is widely used in the treatment of fracture, bone defect, osteoporosis and other orthopedic diseases, and has achieved good effects. Purpose of this trial was to explore efficacy of TFRD on bone graft’s mineralization and osteoblasts’ differentiation in Masquelet induced membrane technique in rats. Forty male Sprague-Dawley rats were randomly divided into high dose group (H-TFRD), middle dose group (M-TFRD), low dose group (L-TFRD) and control group (control). The critical size bone defect model of rats was established with 10 rats in each group. Polymethyl methacrylate (PMMA) spacer was implanted into the defect of right femur in rats. After the formation of the induced membrane, autogenous bone was implanted into the induced membrane. After 12 weeks of bone graft, bone tissues in the area of bone graft were examined by X-ray, Micro-CT, hematoxylin-eosin (HE) and Masson trichrome staining to evaluate the growth of the bone graft. The β-catenin, c-myc, COL1A1, BMP-2 and OPN in bone graft were quantitatively analyzed by Western blot and Immunohistostaining. Osteoblasts were cultured in the medium containing TFRD. Cell Counting Kit-8 (CCK-8) method, Alkaline phosphatase (ALP) and Alizarin Red S (ARS) staining, Western blot, RT-PCR and other methods were used to detect the effects of TFRD on the proliferation of osteoblasts and the regulation of Wnt/β-catenin signaling pathway. In vivo experiments showed that the growth and mineralization of bone graft in TFRD group was better. Moreover, the expression of Wnt/β-catenin and osteogenesis-related proteins in bone tissue of TFRD group was more than that in other groups. In vitro experiments indicated that osteoblasts proliferated faster, activity of ALP was higher, number of mineralized nodules and proteins related to osteogenesis were more in TFRD group. But blocking Wnt/β-catenin signaling pathway could limit these effects. Therefore, TFRD could promote mineralization of bone graft and differentiation of osteoblasts in a dose-dependent manner during growing period of the bone graft of induced membrane technique, which is partly related to the activation of Wnt/β-catenin signaling pathway.

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