The use of free nonvascularized fibular graft in the induced membrane technique to manage post-traumatic bone defects

El-Alfy, Barakat; Abulsaad, Mazen; Abd-el-naby, Wail Lotfy

doi:10.1007/s00590-018-2153-7

Cited by 14 publications

(11 citation statements)

References 13 publications

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“…In the acute phase, the intramedullary cavity is the main infection, often accompanied by high fever, chills, and other sepsis symptoms [ 3 , 4 ]. In the chronic phase, due to necrosis and infection of the skin and muscle around the fracture end, the blood supply is missing, and the fracture end is directly exposed to the air, resulting in drying and necrosis, so that the adjacent granulation tissue cannot be attached [ 5 , 6 ]. After soft tissue atrophy, the area of osteonecrosis is further expanded, which is easy to cause bone nonunion or bone defect, which seriously affects the quality of life of patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma

Wang

Liu

Qiu

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Bone infection is one of the common complications of orthopedic surgery. After bone trauma occurs in the human body, the infection of Staphylococcus aureus and Gram-negative bacteria into the fracture area can lead to double infection of the soft tissue and bone tissue at the fracture site, leading to a variety of complications, mostly in the lower extremities. Bone infection easily causes bone destruction, bone nonunion, and bone defect, seriously affecting the quality of life of patients. The traditional treatment method of bone infection is to control the infection first and then repair the bone graft, but this method has a long course, poor efficacy, and high disability rate. In this study, anti-infective reconstituted bone xenograft (ARBX) combined with external fixation was used to treat patients with posttraumatic bone infections of the long bones of the lower extremities, to explore its efficacy, and to analyze its effects on serum CRP, PCT levels, and prognosis. Our results showed that ARBX combined with the external fixator had a good effect on the treatment of patients with bone infection after lower extremity long bone trauma, which could effectively enhance the repair and functional recovery of the limb bone, significantly alleviate the infection degree of patients, reduce the inflammatory response of the body, and have a good prognosis.

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Section: Introductionmentioning

confidence: 99%

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma

Wang

Liu

Qiu

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…In a previous study, which compared bifocal and trifocal (double-level) bone transport using traditional Ilizarov methods, the external fixation index was 32.9 ± 9.21 days/cm in TF group, and 62.21 ± 24.60 days/cm in BF group [ 31 ]. There were a few other published studies that discussed using the Ilizarov bone transport technique to treat massive tibial defects caused by osteomyelitis, which were summarized in Table 4 for comparison [ 11 , 21 , 41 – 51 ]. The differences in EFI can be ascribed to the etiology of the osteomyelitis as well as the size of the bone defect.…”

Section: Discussionmentioning

confidence: 99%

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

Hamiti

Yushan

et al. 2021

BMC Surg

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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.

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“…El-Alfy et al 34 presented the result of 15 patients with segmental skeletal defects who were treated with the induced membrane technique using a free nonvascularized fibular autograft. They placed the fibula strut autograft into the medulla of the bone proximal and distal to the defect and, if needed, stabilized it with screws.…”

Section: Discussionmentioning

confidence: 99%

Adding a Fibular Strut Allograft to Intramedullary Nail and Cancellous Autograft During Stage II of the Masquelet Technique for Segmental Femur Defects: A Technique Tip

et al. 2020

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Reconstruction of segmental diaphyseal bone defects has been a major challenge in limb salvage surgery. Staged reconstruction as first described by Masquelet is a common strategy to deal with this problem in limb salvage surgery. One consequence of this technique is a time period of prolonged limited weightbearing while the segmental defect heals. The purpose of this study was to describe an adjunctive technique for stage II of the Masquelet procedure and retrospectively analyze the outcome and weight bearing progression of 3 patients who sustained femur fractures with significant bone loss and underwent this technique. A retrospective chart review was performed. The patients (2 males, 1 female with an average age of 36.6 years) all sustained segmental femur fractures which resulted in significant bone loss. Induced membrane technique with adjunct use of a fibular strut allograft was performed after initial stabilization and PMMA spacer placement. All three patients went on to union and full weight bearing after being treated by the described technique. All the patients were allowed toe-touch weight bearing immediately after surgery and all progressed to weight bearing as tolerated at an average of 3.6 months. Using a fibular strut allograft as an adjunct to the induced membrane technique serves as a biologic and mechanical scaffold and may allow earlier weightbearing.

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The use of free nonvascularized fibular graft in the induced membrane technique to manage post-traumatic bone defects

Abstract: The use of free nonvascularised fibular graft in the induced membrane technique reduces the time of healing and improves the final outcome.

Cited by 14 publications

References 13 publications

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma

Effect of Anti-Infective Reconstituted Bone Xenograft Combined with External Fixator on Serum CRP and PCT Levels and Prognosis of Patients with Bone Infection after Lower Extremity Long Bone Trauma

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

Adding a Fibular Strut Allograft to Intramedullary Nail and Cancellous Autograft During Stage II of the Masquelet Technique for Segmental Femur Defects: A Technique Tip

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