Functional outcomes and health-related quality of life after reconstruction of segmental bone loss in femur and tibia using the induced membrane technique

Abstract

Introduction The induced membrane technique (IMT), frequently called Masquelet technique, is an operative, two-staged technique for treatment of segmental bone loss. Previous studies mainly focused on radiological outcome parameters and complication rates, while functional outcomes and health-related quality of life after the IMT were sparsely reported. Materials and methods Retrospective study containing of a chart review as well as a clinical and radiological follow-up examination of all patients treated with the IMT at a single institution. The clinical outcomes were evaluated using the Lower Extremity Functional Scale (LEFS), the Short-Form-36 (SF-36) and the visual analog scale (VAS) for pain. The radiographic evaluation contained of standard anteroposterior and lateral, as well as hip-knee-ankle (HKA) radiographs. Results Seventeen patients were included in the study. All had suffered high-energy trauma and sustained additional injuries. Ten bone defects were localized in the femur and seven in the tibia. Ten patients underwent additional operative procedures after IMT stage 2, among them three patients who contracted a postoperative deep infection. The median LEFS was 59 (15–80), and the SF-36 physical component summary (PCS) and mental component summary (MCS) were 41.3 (24.0–56.1) and 56.3 (13.5–66.2), respectively. The median length of the bone defect was 9 (3–15) cm. In 11 patients, union was obtained directly after IMT stage 2. Bone resorption was observed in two patients. At follow-up, 16 of the 17 bone defects had healed. The median follow-up was 59 months (13–177). Conclusion Our results show a high occurrence of complications after IMT stage 2 in segmental bone defects of femur and tibia requiring additional operative procedures. However, fair functional outcomes as well as a good union rate were observed at follow-up.

The Concept of Scaffold-Guided Bone Regeneration for the Treatment of Long Bone Defects: Current Clinical Application and Future Perspective

“…Particularly in infected or potentially infected long bone defects, the application of the Masquelet technique with antibiotic spacer implantation after excision of any necrotic or infected bone will remain a remarkable feature and very valuable in the treatment [66]. However, case series studies of the treatment of tibial non-union defects applying the Masquelet technique have shown variable success rates and regularly required multiple additional surgeries [217][218][219][220]. Moreover, a meta-analytic estimate of the union rate independent of defect size using Masquelet technique in the tibia was found to be 84% (95% CI, 79-88%) [221].…”

Current Management of Acute and Posttraumatic Critical Bone Defects

“…In one of the first analyses, 50% of patients still used an assistive device for mobilization, 15% had resumed sports, and only 8% of patients had resumed running. 75 Grün et al 82 used the Short Form 36 (SF-36) (higher score = better function), and Lower Extremity Functional Scale (range 0–80 points), to evaluate functional outcomes in their series of patients treated with the induced membrane technique. The median Lower Extremity Functional Scale was 59 (15–80), the SF-36 Physical Component summary was 41.3 (24.0–56.1), and SF-36 Mental Component summary was 56.3 (13.5–66.2).…”