Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: Preliminary results of five cases

Pannier, Stéphanie; Péjin, Zagorka; Dana, Caroline; Masquelet, A. C.; Glorion, Christophe

doi:10.1007/s11832-013-0535-2

Cited by 51 publications

(29 citation statements)

References 29 publications

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“…Hence, most of the reported cases are segmental bone defect of the diaphyseal part of the long bones [5,11,[13][14][15][16][17][18][19][20][21][22]. In our experience, we used this technique mostly for the tibia and the femur but also for the humerus and the radius.…”

Section: Remaining Questionsmentioning

confidence: 99%

Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences

Aurégan

Bégué

2014

International Orthopaedics (SICOT)

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Section: Remaining Questionsmentioning

confidence: 99%

Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences

Aurégan

Bégué

2014

International Orthopaedics (SICOT)

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“…Bone union with complete integration of the graft and cortical reconstitution is achieved between 1 year and 2 years postoperatively, depending on the underlying disease. Initially developed in septic pseudarthrosis excision in adults, this reconstructive procedure has also been applied to traumatic bone loss, tumour resection and reconstruction (Biau et al ., ; Villemagne et al ., ; Chotel et al ., ), congenital pseudarthrosis of the tibia (Gouron et al ., ; Pannier et al ., ) and reconstruction of bone defects in children (Gouron et al ., , ).…”

Section: Introductionmentioning

confidence: 97%

Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique

Gouron

Petit

Boudot

et al. 2014

J Tissue Eng Regen Med

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In 2000, Masquelet reported a long bone reconstruction technique using an induced membrane formed around a polymethylmethacrylate (PMMA) spacer placed in the defect with appropriate stabilization followed by secondary bone graft after PMMA removal. This reconstruction procedure allows rapid and safe bone reformation for septic, traumatic, neoplastic or congenital bone defects. A rat model of the Masquelet technique was developed to further characterize the biological activities of this induced membrane. Our model allows healing of a critical-sized femoral defect (8 mm) by means of this procedure over a period of 18 weeks. Comparison of induced membranes obtained 3, 4, 5 and 6 weeks after PMMA insertion indicated that this tissue changes over time. Several mineralization spots and bone cells were observed in contact with the PMMA, when assessed by Alizarin Red, Von Kossa, Alkaline phosphatase and Tartrate-resistant acid phosphatase staining of the membranes. CTR (calcitonin receptor)- and RANK (Receptor Activator of Nuclear factor Kappa B)- positive mononuclear cells were detected in the induced membrane, confirming the presence of osteoclasts in this tissue. These cells were observed in a thin, highly cellular layer in the induced membrane in contact with the PMMA. Together, these findings suggest that the membrane is able to promote osteointegration of autologous corticocancellous bone grafts during the Masquelet technique by creating local conditions that may be favourable to graft bone remodelling and osteointegration. Copyright © 2014 John Wiley & Sons, Ltd.

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“…Gouron et al (8) and Pannier et al (9) reported its use in the treatment of congenital pseudarthrosis of the tibia, which resulted in satisfactory bony union. Villemagne et al (10) adopted this method to reconstruct the long bone defect following resection of the malignant bone tumor, indicating that this simple and reliable technique may lead to promising clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Since the first study, the Masquelet technique has been widely used to resolve massive bone defects caused by different diseases and achieved clinical efficacy (8)(9)(10)(11)(12). However, efficacy in the cases managed by the Masquelet technique does not mean that this approach is optimal.…”

Section: Introductionmentioning

confidence: 99%

Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer: A case report and hypothesis

Jiang

Qin

et al. 2016

Biomedical Reports

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Abstract. In addition to autologous bone graft, vascularized fibular autograft and Ilizarov bone transfer, the Masquelet technique is another effective method to reconstruct bone defects. This technique was initially proposed in 1986 and consists of two stages. At the first stage, radical debridement is required and subsequently, a polymethylmethacrylate (PMMA) cement spacer is implanted at the site of the bone defects. At the second stage, when the PMMA-induced membrane is formed 6-8 weeks later, the cement spacer is carefully removed in order to not disturb the induced membrane and the bone graft is performed to fill the bone defects. Although this technique has resulted in satisfactory outcomes in the reconstruction of bone defects, the PMMA spacer used to induce membrane is not degradable and requires surgical removal. In recent years, calcium sulfate has been used as a localized antibiotic delivery vehicle and bone substitute due to its superiorities over PMMA, particularly its completely degradable nature. The present study identified that calcium sulfate can also induce the formation of a membrane. In addition, we hypothesized that the degradability of calcium sulfate may allow one-stage reconstruction of bone defects. The current study presents a clinical case report and review of the literature. IntroductionThe aim of bone defect reconstruction is to regenerate bone loss and restore limb function (1). Several approaches can be adopted in the clinic, including autologous bone graft, vascularized fibular autograft and the Ilizarov bone transfer technique. Autologous bone graft is not recommended for reconstruction of massive bone defects due to its increased risk of resorption (2). Vascularized fibular autograft and the Ilizarov bone transfer technique are the most frequently used methods for reconstruction of extensive bone defects (3-5).The Masquelet technique is another effective way to repair extensive bone defects. This two-staged method for bone reconstruction was first described by Masquelet et al in 1986 (6). The first-stage surgery includes radical debridement of bone and soft tissues, followed by implantation of a polymethylmethacrylate (PMMA) cement spacer at the site of the bone defects. The cement spacer is expected to obviate invasion of fibrous tissue at the recipient site (mechanical role) and induce the surrounding membrane (biological role) (7). After a duration of 6 to 8 weeks, a PMMA-induced pseudosynovial membrane formed. At the second-stage surgery, the cement spacer is removed carefully in order to maintain the already formed membrane and cause minimal disturbance. Following this, the defect is filled with morcellised cancellous autologous bone graft. Masquelet et al (6) reported that this method could repair a bone defect of 25 cm in length.Since the first study, the Masquelet technique has been widely used to resolve massive bone defects caused by different diseases and achieved clinical efficacy (8-12). However, efficacy in the cases managed by the Masquelet technique does not me...

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Induced membrane technique for the treatment of congenital pseudarthrosis of the tibia: Preliminary results of five cases

Cited by 51 publications

References 29 publications

Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences

Induced membrane for treatment of critical sized bone defect: a review of experimental and clinical experiences

Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique

Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer: A case report and hypothesis

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