Reconstruction of massive tibial defect caused by osteomyelitis using induced membrane followed by trifocal bone transport technique: a retrospective study and our experience

Abstract

Objective To evaluate clinical outcomes of the application of induced membrane followed by trifocal bone transport technique in the treatment of massive tibial defect caused by osteomyelitis. Method A total of 18 eligible patients with tibial defect > 6 cm caused by osteomyelitis who were admitted to our institution from January 2010 to January 2016 and treated by induced membrane followed by trifocal bone transport technique. There were 12 male and 6 females with an average age of 40.4 years old. A detailed demographic data (age, sex, etiology, previous operation time, defect size and location, interval from Masquelet technique to trifocal bone transport technique, external fixation index (EFI), duration of regenerate consolidation and docking union) were collected, bone and functional outcomes were evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Complications during and in the period of follow up were recorded and evaluated by Paley classification at a minimum follow-up of 2 years. Results The etiology include posttraumatic osteomyelitis in 13 cases and primary osteomyelitis in 5 cases. An average of previous operation time was 3.4 times. Mean tibial defect after radical debridement was 6.8 cm. An average interval duration from formation of induced membrane to trifocal bone transport was 4.8 weeks. An average of EFI was 37.1 days/cm, the duration of regenerate consolidation and docking union were 124.7 days and 186.4 days, respectively. An average time of follow-up after removal of external fixator was 28.5 month without recurrence of osteomyelitis. The bony outcome was excellent in 6 cases, good in 8 cases, fair in 3 cases and poor in 1 case, and functional outcome was excellent in 4 cases, good in 10 cases, fair in 2 cases and poor in 2 cases. The most common complication was pin tract infection which occurred in 15 cases and there were no major complications such as nerve or vascular injury. Conclusion Massive tibial defect caused by osteomyelitis can be successfully treated first stage using induced membrane followed by second stage using trifocal bone transport technique, which is an effective method in terms of radical elimination of osteomyelitis with expected clinical outcomes.

Docking site interventions following bone transport using external fixation: a systematic review of the literature

“…The initial search identified 1251 publications. Twenty-three of these met the eligibility criteria for the pooled analysis, including 1153 patients treated by distraction osteogenesis [ 8 , 12 , 14 , 15 , 22 – 28 , 31 – 42 ]. Details of each study are shown in Table 1 .…”

“…Two studies in the observed group reported the use of either poly-methyl methacrylate or calcium sulphate bone cement within the defect (54 patients) [ 22 , 37 ]. The rationale for this is to induce a biologically active membrane to assist union and regenerate formation.…”

“…Combination with internal fixation can be undertaken to reduce external fixator time [ 19 – 21 ]. There are also reports of utilising membrane induction as in the Masquelet technique in an attempt to improve healing [ 22 ]. Regardless of technique, the result is the apposition of the two opposing surfaces of the bone defect at the “docking site”.…”

Long Bone Defect Filling with Bioactive Degradable 3D-Implant: Experimental Study

“…Combination of Masquelet technique (induced membrane technique) followed by Ilizarov bone transport demonstrated effectiveness in the treatment of nonunions of long bones [ 51 , 52 ]. The bone transport through induced membrane chamber allowed improving outcomes and avoiding bone grafting.…”

Trifocal versus Pentafocal bone transport in segmental tibial defects: a matched comparative analysis for posttraumatic osteomyelitis treatment

“…In addressing this concern, a range of therapeutic approaches have been recognized as efficacious. Autologous bone grafts, the induced membrane technique, the Ilizarov method (based on distraction osteogenesis principles), and vascularized and nonvascularized fibular grafting techniques are among the methodologies that can be implemented [ 5 – 13 ]. Determining the most appropriate treatment strategy is contingent upon a multitude of crucial considerations, encompassing the defect’s precise site and extent, as well as any additional injuries.…”