Management of septic non-union of the tibia by the induced membrane technique. What factors could improve results?

Joseph, Etienne; Blasco, Laurent; Barbe, Coralie; Bajolet, Odile; Diallo, S.; Ohl, Xavier

doi:10.1016/j.otsr.2018.04.013

Cited by 50 publications

(37 citation statements)

References 20 publications

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“…We analyzed the related factors involved in the bone union time and improvement of function of the lower extremities, which was defined as the difference between LEFS measured before first stage and about 1 year after the third stage, and discovered that defect size, type of bone graft, debridement times, and spacer-placing time did not influence bone union time or the change in LEFS after 1 year of the third stage. The findings were previously reported [3,33,34. The bone union time and improvement of lower-extremities function in a limited time were more affected by age, duration of infected bone defects, active smoking, and final fixation method in our series.…”

Section: What Factors Influence the Outcomes Of Treatment?supporting

confidence: 87%

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Zhang

Zhu

et al. 2020

Med Sci Monit

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Departmental sources Background: Infected bone defects are therapeutic challenges. Although the induced membrane technique has been used for this problem, there is a 3% to 20.7% failure to eradicate infection, and there have been few reports about its use in tuberculous infection. We present our three-stage induced membrane technique (TSIMT) for treating infected bone defects of the lower extremity. Material/Methods: Forty-one adult patients with infected bone defects of the lower extremities treated by TSIMT were included in a retrospective case-series study between January 2013 and June 2018. The clinical, imaging and laboratory assessment outcomes were analyzed. Results: In the first stage, 3 patients had ankle tuberculous bone defects and 17 patients underwent 2-4 debridements. In the second stage, the average bone defect was 6.0 cm; 1 patient needed an anterolateral thigh flap to cover the wound. In the third stage, 10 patients underwent autograft mixed allograft, and 18 cases used internal fixation. The mean follow-up period was 23.3 months. All patients achieved bone union and clinical eradication of infection. Changes in Lower Extremity Functional Scale (LEFS) scores after 1 year of TSIMT and bone union time are associated with advanced age, longer duration of infected bone defects, active smoking, and external fixation (p<0.05), but are not dependent on bone defect size, debridement times, type of bone graft, or spacer-placing time (p>0.05). Conclusions: TSIMT is effective in treating infected bone defects of the lower extremities. Advanced age, longer duration of infected bone defects, active smoking, and external fixation adversely affect bone union and recovery of infected extremities in a limited time span.

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Section: What Factors Influence the Outcomes Of Treatment?supporting

confidence: 87%

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Zhang

Zhu

et al. 2020

Med Sci Monit

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“…Some clues explaining the complications and failures in IMT are provided in the literature. Data from several sources highlight either the recurrence of sepsis, active smoking, or lack of rigid fixation after the second operative step as participants in IMT clinical failures [13][14][15][16]. However, available studies in the area are, to date, either prospective or retrospective epidemiologic studies.…”

Section: Introductionmentioning

confidence: 99%

Towards Understanding Therapeutic Failures in Masquelet Surgery: First Evidence that Defective Induced Membrane Properties are Associated with Clinical Failures

Durand¹,

Barbier²,

Laurent

et al. 2020

JCM

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The two-stage Masquelet induced-membrane technique (IMT) consists of cement spacer-driven membrane induction followed by an autologous cancellous bone implantation in this membrane to promote large bone defect repairs. For the first time, this study aims at correlating IMT failures with physiological alterations of the induced membrane (IM) in patients. For this purpose, we compared various histological, immunohistochemical and gene expression parameters obtained from IM collected in patients categorized lately as successfully (Responders; n = 8) or unsuccessfully (Non-responders; n = 3) treated with the Masquelet technique (6 month clinical and radiologic post-surgery follow-up). While angiogenesis or macrophage distribution pattern remained unmodified in non-responder IM as compared to responder IM, we evidenced an absence of mesenchymal stem cells and reduced density of fibroblast-like cells in non-responder IM. Furthermore, non-responder IM exhibited altered extracellular matrix (ECM) remodeling parameters such as a lower expression ratio of metalloproteinase-9 (MMP-9)/tissue inhibitor of metalloproteinases (TIMP-1) mRNA as well as an important collagen overexpression as shown by picrosirius red staining. In summary, this study is the first to report evidence that IMT failure can be related to defective IM properties while underlining the importance of ECM remodeling parameters, particularly the MMP-9/TIMP-1 gene expression ratio, as early predictive biomarkers of the IMT outcome regardless of the type of bone, fracture or patient characteristics.

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“…During the first phase of Masquelet, the bone defects filling with bone cement (polymethyl methacrylate, PMMA) spacer are fixed with internal plate, intramedullary nail, external fixator, casting, or nothing 12 , 17 , 19 – 21 . But it is not sure that which fixation method is more appropriate for membrane formation in the first stage of Masquelet 13 , 22 – 24 . It is known that the stiffness of fixation construct directly affects the fretting of fracture fragments, subsequently impacts the healing of bone fracture.…”

Section: Introductionmentioning

confidence: 99%

Effects of topical mechanical stability on the formation of Masquelet membrane in a rabbit radial defect model

Xie

Liu

Wang

et al. 2020

Sci Rep

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The exact mechanism of Masquelet technique is unknown. This study intends to explore the effects of topical mechanical stability on the formation of Masquelet membrane. Segmental radius shaft defect was created in all rabbits, which were filled with polymethylmethacrylate (PMMA) in Non-fixation group, and with PMMA fixed with plates in Fixation group, and subjected to no disposal in control group. The topical stability of PMMA and plates were monitored via X-ray and mechanical test. And the membranes were excised for further Histological, IHC and Western-Blotting analysis 4 and 6 weeks post-operatively. X-ray revealed no sign of plates loosening, or shift of PMMA. Mechanical tests revealed superior topical stability by plates. Pathological examinations suggested that vascularized and osteogenic membranes were formed around PMMA. IHC and Western-Blotting analysis revealed that both Fixation and Non-fixation group exerted significant effects on the expression of Ki67, COL I, and CD31 positive cells, as well as the protein expression of osteogenic (RUNX2, ALP) and angiogenic (VEGFA, TGF-β1) factors. And compared with membrane in Non-fixation group, Fixing PMMA spacer with plates caused a significant increase in osteogenic and angiogenic expression. This study indicates that rigid fixation provided by plate in Masquelet technique positively alters the quality of membrane formed surrounding PMMA, in terms of significantly osteogenic and angiogenic potential.

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Management of septic non-union of the tibia by the induced membrane technique. What factors could improve results?

Abstract: IV, Retrospective study.

Cited by 50 publications

References 20 publications

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Towards Understanding Therapeutic Failures in Masquelet Surgery: First Evidence that Defective Induced Membrane Properties are Associated with Clinical Failures

Effects of topical mechanical stability on the formation of Masquelet membrane in a rabbit radial defect model

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