Results of the Induced Membrane Technique in the Management of Traumatic Bone Loss in the Lower Limb: A Cohort Study

Giotikas, D; Tarazi, Nadim; Spalding, Lynette; Nabergoj, Marko; Krkovič, Matija

doi:10.1097/bot.0000000000001384

Cited by 32 publications

(25 citation statements)

References 23 publications

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“…Antibiotics‐loaded calcium sulfate can release antibiotics via zero‐order kinetics and layer‐by‐layer surface degradation. Thus, calcium sulfate provides a sustainable releasing rate of antibiotics and remains at a therapeutic dose for extended periods, which is not conducive to bacterial growth [10]. However, antibiotics‐loaded calcium sulfate also has intrinsic drawbacks, such as its deficient mechanical support for the bone structure, which is a critical factor for chronic osteomyelitis [11].…”

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confidence: 99%

A dual PMMA/calcium sulfate carrier of vancomycin is more effective than PMMA‐vancomycin at inhibiting Staphylococcus aureus growth in vitro

et al. 2020

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Both antibiotic‐impregnated poly(methyl acrylate, methyl methacrylate) (PMMA) and antibiotic‐impregnated calcium sulfate have been successfully used as local antibiotic delivery vehicles for the management of chronic osteomyelitis. Here, we examined the antibiotic elution characteristics and antibacterial properties of a composite drug delivery system consisting of PMMA/calcium sulfate carrying vancomycin (dual carrier‐v) against Staphylococcus aureus, with PMMA loaded with vancomycin (PMMA‐v) as a control. Vancomycin gradually degraded from dual carrier‐v and PMMA‐v up to about 8 and 6 weeks, respectively. At different elution time points, the inhibition zones of the dual carrier‐v were larger than the inhibition zones of the PMMA‐v (P < 0.05). The colony inhibition rate of the dual carrier‐v was 95.57%, whereas it was 77.87% for PMMA‐v. Scanning electron microscopy was used to demonstrate biofilm formation on the surface of plates treated with vancomycin‐unloaded PMMA, whereas there was no biofilm formation on the surface of plates treated with dual carrier‐v or PMMA‐v. The dual carrier‐v was more effective at antibacterial adhesion at each time point after immersion in simulated body fluid as compared with PMMA‐v (P < 0.05). In conclusion, our results suggest that the dual carrier‐v can release higher concentrations of antibiotics and inhibit bacteria growth more effectively in vitro as compared with PMMA‐v. The dual carrier‐v thus may have potential as an alternative strategy for osteomyelitis management.

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A dual PMMA/calcium sulfate carrier of vancomycin is more effective than PMMA‐vancomycin at inhibiting Staphylococcus aureus growth in vitro

et al. 2020

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“…First, whether the environment for new bone formation is infected can affect the failure or success of this practice. [34][35][36] Second, successful treatment is related to the capacity for bone healing of such large bone defects. 28,29,32 Antibiotic powder mixed with supplemental bone grafts may be an alternative to control bacterial growth during bone healing.…”

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confidence: 99%

<p>A Three-Dimensional Printed Polycaprolactone Scaffold Combined with Co-Axially Electrospun Vancomycin/Ceftazidime/Bone Morphological Protein-2 Sheath-Core Nanofibers for the Repair of Segmental Bone Defects During the Masquelet Procedure</p>

Lee

Hsu

et al. 2020

IJN

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Introduction: Masquelet proposed a new solution for the healing of segmental bone defects, thus minimizing the disadvantages associated with traditional bone grafting. However, a major factor leading to the failure of this technique pertains to be the residual infection. Accordingly, we developed an antibiotic-and osteo-inductive agent-loaded composite scaffold to solve this problem. Methods: A mesh-like polycaprolactone scaffold was prepared using a lab-exploited solutiontype three-dimensional printer, and hybrid sheath-core structured poly(lactic-co-glycolic-acid) nanofibers were fabricated using co-axial electrospinning technology. Vancomycin, ceftazidime, and bone morphological protein (BMP)-2 were employed. The in vitro and in vivo (rabbit fracture model) release patterns of applied agents from the composite scaffold were investigated. Results: The results revealed that the drug-eluting composite scaffold enabled the sustainable release of the medications for at least 30 days in vitro. Animal tests demonstrated that a high concentration of medications was maintained. Abundant growth factors were induced within the bioactive membrane stimulated by the applied scaffold. Finally, satisfactory bone healing potential was observed on radiological examination and biomechanical evaluation. Discussion: The developed composite scaffold may facilitate bone healing by inducing bioactive membrane formation and yielding high concentrations of antibiotics and BMP-2 during the Masquelet procedure.

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“…Несмотря на неоспоримые успехи в реконструктивно-восстановительной хирургии больших диафизарных костных дефектов (протяженностью до 20 см) методом Masquelet [6,28], ортопеды констатируют высокие риски рецидива процесса и достаточно высокую частоту осложнений, составляющую в среднем около 18% [23], колеблющуюся, по данным разных авторов, от 9% до 59% [7,23,29,30]. Основными осложнениями при использовании метода Masquelet являются несращения костных отломков, лизис и переломы костного трансплантата, развитие раневой инфекции, появление несоответствия длины конечностей, контрактуры суставов, рецидивы и ампутации [5,7,28,29,30,31].…”

Section: Morphological Changes In the Tibial Nerve During The Treatmeunclassified

Morphological Changes in the Tibial Nerve During the Treatment of Large Tibia Defects Using Ilizarov Apparatus Combining with the Masquelet Technique: Experimental Study

Варсегова

Дюрягина

Еманов

et al. 2020

Traumatology and Orthopedics of Russia

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Background. The use of Masquelet technology in combination with non-free osteoplasty according to Ilizarov in order to compensate large defects of the lower leg bones provides proper bone union and recurrence-free course of the disease, but the problem of patient rehabilitation remains relevant. The course and duration of the recovery period depend on the morphofunctional state of the tibial nerves. The purpose of this study was to determine morphological changes in the tibia nerve of dogs during the experimental treatment of large tibial defects using Ilizarov apparatus combining with the Masquelet technique. Materials and Methods. A defect of the upper third of the tibia in the form of false joint was created in 10 mongrel dogs. Then this defect was replaced with 25 mm diastasis, into which a cement spacer was placed. After 30 days, the latter was removed. At the level of the lower third, transverse osteotomy was performed, as well as distraction of 1 mm rate for 4 times per day, until complete contact of the fragments in the defect zone. The tibial nerves were studied within the periods of 60 days of fixation (F60) and 30 days after the fixator removal (FR30). Results. There were no mechanical damages of the nerves. During the experiment a part of epineural veins and arteries had obliterated lumens, two-fold decrease in the numerical density of endoneural arterioles, venules and capillaries was observed in FR30 — 97.5±2.5 in 1 mm2 (normally — 182.0±22.0), that evidenced of microcirculatory disorders progressing towards the end of the experiment. Patterns of Wallerian degeneration were found along with typical damages to fibers during distraction osteosynthesis demyelination and axonal degeneration. In F60 the proportion of modified fibers was 7.7±1.5%, which was 4.8 times higher (р = 0.52×10-5) above normal, the numerical densities and dimensional characteristics of fibers decreased. At the end of the experiment, the proportion of modified conductors 2.3-fold exceeded the norm (p = 0.33×10-4) — 3.7±0.4%, the numerical density of fibers remained 10.2% below the norm (p = 0.0362), making up 17436±865, but the average axon diameter and thickness of myelin sheaths were restored. Conclusion. Microcirculatory dysfunction, axonal atrophy, demyelination, Wallerian degeneration of a part of myelin nerve fibers and a decrease in their number revealed in the tibial nerves during the treatment of large tibia defects using the Masquelet technique combining with Ilizarov non-free bone grafting indicated the need for the use of adequate neurometabolic pharmacotherapy and effective rehabilitation.

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Results of the Induced Membrane Technique in the Management of Traumatic Bone Loss in the Lower Limb: A Cohort Study

Cited by 32 publications

References 23 publications

A dual PMMA/calcium sulfate carrier of vancomycin is more effective than PMMA‐vancomycin at inhibiting Staphylococcus aureus growth in vitro

A dual PMMA/calcium sulfate carrier of vancomycin is more effective than PMMA‐vancomycin at inhibiting Staphylococcus aureus growth in vitro

<p>A Three-Dimensional Printed Polycaprolactone Scaffold Combined with Co-Axially Electrospun Vancomycin/Ceftazidime/Bone Morphological Protein-2 Sheath-Core Nanofibers for the Repair of Segmental Bone Defects During the Masquelet Procedure</p>

Morphological Changes in the Tibial Nerve During the Treatment of Large Tibia Defects Using Ilizarov Apparatus Combining with the Masquelet Technique: Experimental Study

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