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Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”

BACKGROUND: Gap nonunion of long bones is a challenging problem, due to the limitation of conventional reconstructive techniques more so if associated with infection and soft tissue defect. Treatment options such as autograft with non-vascularized fibula and cancellous bone graft, vascularized bone...

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Autores principales: Gupta, Gaurav, Ahmad, Sohail, Mohd. Zahid, Khan, A H, Sherwani, M K A, Khan, Abdul Qayyum
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885298/
https://www.ncbi.nlm.nih.gov/pubmed/27293290
http://dx.doi.org/10.4103/0019-5413.181780
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author Gupta, Gaurav
Ahmad, Sohail
Mohd. Zahid,
Khan, A H
Sherwani, M K A
Khan, Abdul Qayyum
author_facet Gupta, Gaurav
Ahmad, Sohail
Mohd. Zahid,
Khan, A H
Sherwani, M K A
Khan, Abdul Qayyum
author_sort Gupta, Gaurav
collection PubMed
description BACKGROUND: Gap nonunion of long bones is a challenging problem, due to the limitation of conventional reconstructive techniques more so if associated with infection and soft tissue defect. Treatment options such as autograft with non-vascularized fibula and cancellous bone graft, vascularized bone graft, and bone transportation are highly demanding on the part of surgeons and hospital setups and have many drawbacks. This study aims to analyze the outcome of patients with wide diaphyseal bone gap treated with induced-membrane technique (Masquelet technique). MATERIALS AND METHODS: This study included 9 patients (7 males and 2 females), all with tibial bone-gap. Eight of the 9 patients were infected and in 3 patients there was associated large soft tissue defect requiring flap cover. This technique is two-stage procedure. Stage I surgery included debridement, fracture stabilization, application of spacer between bone ends, and soft tissue reconstruction. Stage II surgery included removal of spacer with preservation of induced membrane formed at spacer surface and filling the bone-gap with morselized iliac crest bone-graft within the membrane sleeve. Average bone-gap of 5.2 cm was treated. The spacer was always found to be encapsulated by a thick glistening membrane which did not collapse after its removal. All patients were followed up for an average period of 21.5 months. RESULTS: Serial Radiographs showed regular uptake of autograft and thus consolidation within themselves in the region of bone gap and also with host bone. Bone-union was documented in all patients and all patients are walking full weight-bearing without support. CONCLUSIONS: The study highlights that the technique provide effective and practical management for difficult gap nonunion. It does not require specialized equipment, investigations, and surgery. Thus, it provides a reasonable alternative to the developing infrastructures and is a reliable and reproducible technique.
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spelling pubmed-48852982016-06-10 Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique” Gupta, Gaurav Ahmad, Sohail Mohd. Zahid, Khan, A H Sherwani, M K A Khan, Abdul Qayyum Indian J Orthop Original Article BACKGROUND: Gap nonunion of long bones is a challenging problem, due to the limitation of conventional reconstructive techniques more so if associated with infection and soft tissue defect. Treatment options such as autograft with non-vascularized fibula and cancellous bone graft, vascularized bone graft, and bone transportation are highly demanding on the part of surgeons and hospital setups and have many drawbacks. This study aims to analyze the outcome of patients with wide diaphyseal bone gap treated with induced-membrane technique (Masquelet technique). MATERIALS AND METHODS: This study included 9 patients (7 males and 2 females), all with tibial bone-gap. Eight of the 9 patients were infected and in 3 patients there was associated large soft tissue defect requiring flap cover. This technique is two-stage procedure. Stage I surgery included debridement, fracture stabilization, application of spacer between bone ends, and soft tissue reconstruction. Stage II surgery included removal of spacer with preservation of induced membrane formed at spacer surface and filling the bone-gap with morselized iliac crest bone-graft within the membrane sleeve. Average bone-gap of 5.2 cm was treated. The spacer was always found to be encapsulated by a thick glistening membrane which did not collapse after its removal. All patients were followed up for an average period of 21.5 months. RESULTS: Serial Radiographs showed regular uptake of autograft and thus consolidation within themselves in the region of bone gap and also with host bone. Bone-union was documented in all patients and all patients are walking full weight-bearing without support. CONCLUSIONS: The study highlights that the technique provide effective and practical management for difficult gap nonunion. It does not require specialized equipment, investigations, and surgery. Thus, it provides a reasonable alternative to the developing infrastructures and is a reliable and reproducible technique. Medknow Publications & Media Pvt Ltd 2016 /pmc/articles/PMC4885298/ /pubmed/27293290 http://dx.doi.org/10.4103/0019-5413.181780 Text en Copyright: © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Gupta, Gaurav
Ahmad, Sohail
Mohd. Zahid,
Khan, A H
Sherwani, M K A
Khan, Abdul Qayyum
Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”
title Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”
title_full Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”
title_fullStr Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”
title_full_unstemmed Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”
title_short Management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”
title_sort management of traumatic tibial diaphyseal bone defect by “induced-membrane technique”
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885298/
https://www.ncbi.nlm.nih.gov/pubmed/27293290
http://dx.doi.org/10.4103/0019-5413.181780
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