Surgical technique and indications of the induced membrane procedure in children

Abstract

The induced membrane technique is now quite adaptable to segmental bone reconstruction in children. This technique is much the same as the technique used in adults. A cement spacer is interposed, and in a second operating phase, occurring 6 weeks after the interposition of the spacer, the cement is removed and a morselized corticocancellous graft is installed in the induced membrane that had formed around the cement. Graft expansion using allograft chips should not exceed 30% of the total volume. An additional autograft strut is useful in the reconstruction of long femoral or metaphyseal-diaphyseal tibial defects. Despite the apparent simplicity of this technique, it requires rigorous technique during cement sleeving and to stabilize the defect to prevent nonunion, stabilization device loosening, or resorption of the graft, the main complications. This technique is now becoming the gold standard for bone reconstruction in trauma and septic bone surgery. In pediatrics, the Masquelet technique is now mainly used in the context of cancer surgery reconstructions. Constraints related to chemotherapy have led to deferral of the graft, which is therefore empirically performed 8 weeks after the last course of chemotherapy. Congenital anomalies, including congenital pseudarthrosis, may now be treated using this technique, replacing long and difficult conventional treatment. A longer follow-up would be necessary to assess and confirm the superiority of this pediatric reconstruction technique.

Gait analysis in children after the lengthening of the lower limb by the Ilizarov technique

“…Because surgery is only the beginning of long-term physiotherapeutic treatment, which requires many sacrifices from the patient, lengthening of the limbs is done in 6-7-year-old children. Patients at this age much more easily accept the therapy, show better adherence during rehabilitation, and establish a good relationship with medical personnel [3,5,14,19]. In this study the age of children was 7 to 10 years, and did not differ from the age of children treated with the Ilizarov technique reported in the available literature [24,25].…”

“…The last significantly extended subphase is preswing, i.e. the second double support peoraz dobry kontakt z personelem medycznym [3,5,14,19]. W przedstawionych badaniach wiek leczonych dzieci wynosił od 7 do 10 lat.…”

“…2 metres on a marked trajectory. The treadmill platform responding to the tylko danej kończyny, lecz całego ciała [8,9,10,11,12,13,14,15,16,17]. Each child had to walk approx.…”

“…The rehabilitation procedure has to be complex and adjusted to the current stage of treatment. It should be analysed in terms of immediate results (prevention of adverse effects of immobilization, analgesic and anti-inflammatory effects, improved blood flow in the operated on limb, verticalization and learning to walk with crutches) and long-term ones (improved range of motion, increased muscle mass and strength, improved proprioception, functional stabilization, development of a normal gait pattern and posture), associated with both the static and dynamic functions of lower limbs and compensating consequences associated with them, not only affecting the limb, but also the whole body [8,9,10,11,12,13,14,15,16,17].…”

RECONSTRUCTION OF BONE DEFECTS AFTER TUMOR RESECTION BY AUTOAND ALLOGRAFTS (review of literature)

“…К аналогичным выводам приш-ли и другие авторы [33,[39][40][41][42][43][44][45][46][47][48]. по данным лите-ратуры, 5-летняя выживаемость пациентов сос-тавляет 73% и выше, рецидивирование опухоли возникает менее чем в 13%, при этом авторы не связывают эти случаи с применением аллотранс-плантата [39,43,48].…”