Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis

Abstract

ObjectivesInduced membrane technique is a relatively new technique in the reconstruction of large bone defects. It involves the implantation of polymethylmethacrylate (PMMA) cement in the bone defects to induce the formation of membranes after radical debridement and reconstruction of bone defects using an autologous cancellous bone graft in a span of four to eight weeks. The purpose of this study was to explore the clinical outcomes of the induced membrane technique for the treatment of post-traumatic osteomyelitis in 32 patients.MethodsA total of 32 cases of post-traumatic osteomyelitis were admitted to our department between August 2011 and October 2012. This retrospective study included 22 men and ten women, with a mean age of 40 years (19 to 70). Within this group there were 20 tibias and 12 femurs with a mean defect of 5 cm (1.5 to 12.5). Antibiotic-loaded PMMA cement was inserted into the defects after radical debridement. After approximately eight weeks, the defects were implanted with bone graft.ResultsThe patients were followed for 27.5 months (24 to 32). Radiographic bone union occurred at six months for 26 cases (81%) and clinical healing occurred in 29 cases (90%) at ten months. A total of six cases had a second debridement before bone grafting because of recurrence of infection and one patient required a third debridement. No cases of osteomyelitis had recurred at the time of the last follow-up visit.ConclusionThe induced membrane technique for the treatment of post-traumatic osteomyelitis is a simple, reliable method, with good early results. However, there are many challenges in determining the scope of the debridement, type of limb fixation and source of bone graft to be used.Cite this article: Dr Z. Xie. Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis. Bone Joint Res 2016;5:101–105. DOI: 10.1302/2046-3758.53.2000487.

The “Road to Union” protocol for the reconstruction of isolated complex high-energy tibial trauma

“…The results of this study demonstrate that a standardized approach using circular fixation for the management of complex tibial trauma, both acute and chronic in nature, has a high probability of success in a specialized centre. Union was achieved in 91% of all cases, and this is comparable to other previously reported series [24][25][26][27].…”

Induced membrane technique for the treatment of chronic hematogenous tibia osteomyelitis

“…This result could possibly be attributed to the fact that a greater proportion of the allograft was used for our skeletally immature patients. Formerly, we reported the induced membrane for the treatment of posttraumatic osteomyelitis [8]. When comparing the current results with our previous study on the application of the induced membrane technique of post-traumatic osteomyelitis, we found similar clinical efficacy and complications.…”

“…Then, a membrane is formed by implantation of a PMMA cement, and grafting the induced membrane approximately 8 weeks later. The membrane rapidly promotes bone defect repair [8]. …”

“…The inclusion criteria were (1) historical evidence of radiological and clinical bone infection at the tibia; (2) no historical evidence of open fracture or fracture internal fixation at the involved site; (3) local bone pain and swelling on examination, imaging procedures, microbiology and histopathology, and laboratory studies [8]. The gold standard for diagnosis of osteomyelitis is biopsy or culture from deep tissue [9] frozen sections confirmed to have more than five neutrophils per high-power field.…”

“…This technique is recognized and used in the treatment of osteomyelitis [7]. We reported the use of the induced membrane technique for the treatment of 32 cases post-traumatic osteomyelitis and obtained good clinical efficacy [8]. Here, we performed a retrospective analysis of 15 patients with chronic hematogenous tibia osteomyelitis treated with the induced membrane two-stage surgical technique to assess the clinical outcome and provide a reference for this disease.…”