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Lynch TB, Sabbag CM, Wilson DJ, Plucknette BF. Complex Fractures of the Radial and Ulnar Shaft. J Orthop Trauma 2024; 38:S21-S25. [PMID: 39150290 DOI: 10.1097/bot.0000000000002855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2024] [Indexed: 08/17/2024]
Abstract
SUMMARY Successful management of radial and ulnar shaft fractures is an essential skill for all orthopaedic surgeons. The frequent presentation of these injuries coupled with the nuanced anatomic considerations that must be observed for successful outcomes dictate that these injuries require a thorough understanding by the treating surgeon. Intraoperative care to restore the anatomic radial bow and rotation is essential for the resumption of functional forearm rotation postinjury. Often, problems arising during the operative treatment of radial and ulnar shaft fractures come in predictable patterns that can be mitigated with preoperative planning and sound technique. Cases of increased complexity with segmental bone defects and soft tissue defects require a variety of advanced reconstructive techniques.
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Affiliation(s)
- Thomas B Lynch
- San Antonio Military Medical Center, Fort Sam Houston, TX
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Jawahier PA, Waaijer L, d'Ailly PN, Schep NW. Masquelet Procedure for the Treatment of Intra-articular Defects of the Wrist. J Wrist Surg 2023; 12:543-548. [PMID: 38213566 PMCID: PMC10781568 DOI: 10.1055/s-0042-1760123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/18/2022] [Indexed: 01/22/2023]
Abstract
Background The purpose of this case series is to show our experiences with the Masquelet procedure in a variety of infected defects of the wrist. Case Description All consecutive patients that were treated between 2015 and 2021 were included in this case series. Five patients were included with an infected defect of the wrist, involving the radiocarpal and/or the distal radioulnar joints (DRUJ). All patients underwent thorough debridement of the defect and the created void was filled with a gentamicin/vancomycin cement spacer. Cultures were taken and appropriate antibiotic therapy was initiated. Two patients had a renewal of the cement spacer before definitive surgery. Finally, two patients received a DRUJ prosthesis, two patients had autologous bone grafting and wrist arthrodesis and one patient kept the cement spacer as distal ulna prosthesis due to minor complaints. Literature Review Current literature provides examples of the Masquelet procedure in traumatic defects or non-unions of the long bones. These cases are almost always about metaphyseal or diaphyseal defects but rarely include intra-articular joint defects therefore no comparisons could be made between the cases we reported with any existing literature. Clinical Relevance The Masquelet procedure showed to be effective in eradicating infected defects of the wrist involving the radiocarpal joint and/or DRUJ. All patients had an aseptic environment before performing definitive surgery. This technique showed to be save and no reinfections occurred.
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Affiliation(s)
| | - Laurien Waaijer
- Department of Trauma Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Philippe N. d'Ailly
- Department of Hand and Wrist Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Niels W.L. Schep
- Department of Hand and Wrist Surgery, Maasstad Hospital, Rotterdam, The Netherlands
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Komura S, Hirakawa A, Hirose H, Yamamoto K, Matsushita Y, Matsumoto K, Akiyama H. Reconstruction of a severe comminuted distal radius fracture with a large segmental bone defect by dorsal bridge plating combined with a vascularized fibular graft: A case report. J Orthop Sci 2023; 28:1508-1512. [PMID: 34507872 DOI: 10.1016/j.jos.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hitoshi Hirose
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kyosuke Yamamoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasuharu Matsushita
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Hamiti Y, Yalikun A, Lu C, Yusufu A, Yushan M. Ilizarov technique in the treatment of bone defects of the radius and ulna: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:642. [PMID: 37649069 PMCID: PMC10469416 DOI: 10.1186/s13018-023-04126-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023] Open
Abstract
PURPOSE The objective of this systematic review and meta-analysis was to assess the efficacy of the Ilizarov method in the treatment of radius and ulna bone defects. METHODS The PubMed, Embase, Web of Science, Cochrane Library, Ovid MEDLINE, and Scopus databases were searched for articles published up to May 2023. The quality of the studies was evaluated using a modified version of the Newcastle-Ottawa scale. The effect size and confidence intervals at 95% for the main results were calculated. The heterogeneity was evaluated. The demographic data, defect size (DS), external fixation time (EFT), external fixation index (EFI), and complications were extracted and analyzed using the Stata version 16. RESULTS This meta-analysis identified and included seven studies involving 98 patients. The union rate of 100% was reported in all studies. According to the findings of the single-arm meta-analysis, the pooled DS was 3.42 cm (95% CI [2.64, 4.21], I2 = 53.5%, P = 0.045), EFT was 148.43 days (95% CI [97.49, 199.38], I2 = 91.9%, P = 0.000), and EFI was 41.32 days/cm (95% CI [35.72, 46.91], I2 = 62.2%, P = 0.021). Pin tract infection was the most common complication, as reported in six studies. CONCLUSION The findings of the present meta-analysis indicate that the Ilizarov technique is a successful treatment option for bone defects in the radius and ulna. This method has demonstrated efficacy in achieving expected clinical outcomes.
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Affiliation(s)
- Yimurang Hamiti
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Ainizier Yalikun
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Cheng Lu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstructive Surgery, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, Xinjiang, People's Republic of China.
| | - Maimaiaili Yushan
- Department of Orthopedic Surgery, The Fourth Affiliated Hospital of Xinjiang Medical University, Traditional Chinese Medicine Hospital of Xinjiang Uyghur Autonomous Region, Ürümqi, Xinjiang, People's Republic of China.
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Smolinska V, Csobonyeiova M, Zamborsky R, Danisovic L. Stem Cells and Their Derivatives: An Implication for the Regeneration of Nonunion Fractures. Cell Transplant 2023; 32:9636897231183530. [PMID: 37462248 PMCID: PMC10363876 DOI: 10.1177/09636897231183530] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Despite advances in biomedical research, fracture nonunion rates have remained stable throughout the years. Long-bone fractures have a high likelihood of nonunion, but the specific biological pathways involved in this severe consequence are unknown. Fractures often heal in an organized sequence, including the production of a hematoma and an early stage of inflammation, the development of a soft callus and hard callus, and eventually the stage of bone remodeling. Deficient healing can result in a persistent bone defect with instability, discomfort, and loss of function. In the treatment of nonunions, mesenchymal stem cells (MSCs) prove to be a promising and safe alternative to the standard therapeutic strategies. Moreover, novel scaffolds are being created in order to use a synergistic biomimetic technique to rapidly generate bone tissue. MSCs respond to acellular biomimetic matrices by regenerating bone. Extracellular vesicles (EVs) derived from MSCs have recently gained interest in the field of musculoskeletal regeneration. Although many of these techniques and technologies are still in the preclinical stage and have not yet been approved for use in humans, novel approaches to accelerate bone healing via MSCs and/or MSC derivatives have the potential to reduce the physical, economic, and social burdens associated with nonhealing fractures and bone defects. In this review, we focus on providing an up-to-date summary of recent scientific studies dealing with the treatment of nonunion fractures in clinical and preclinical settings employing MSC-based therapeutic techniques.
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Affiliation(s)
- Veronika Smolinska
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
- National Institute of Rheumatic Diseases, Piestany, Slovakia
| | - Maria Csobonyeiova
- National Institute of Rheumatic Diseases, Piestany, Slovakia
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Radoslav Zamborsky
- National Institute of Rheumatic Diseases, Piestany, Slovakia
- Department of Orthopaedics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
- National Institute of Children's Diseases, Bratislava, Slovakia
- Centre for Tissue Engineering and Regenerative Medicine-Translational Research Unit, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
- National Institute of Rheumatic Diseases, Piestany, Slovakia
- Centre for Tissue Engineering and Regenerative Medicine-Translational Research Unit, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovakia
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Oka K, Kaji Y, Nakamura O, Yamaguchi K, Tobiume S, Nomura Y, Yamamoto T. Addition of a Vascular Bundle Accelerates Bone Union in Femoral Bone Defects. J Reconstr Microsurg 2023; 39:1-8. [PMID: 35272371 DOI: 10.1055/s-0042-1743256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Masquelet method has become increasingly popular for the treatment of bone defects in recent years. In this method, an induced membrane (IM) with abundant blood circulation, stem cells, and osteogenesis-promoting factors is formed by implanting bone cement during the first surgery. This IM stimulates bone formation in the bone defect after implantation of the bone graft during the second surgery. However, the Masquelet method requires two surgeries and thus a longer treatment period. In the present study, we investigated whether bone defects could be reconstructed in a single surgery by introducing a vascular bundle into the bone defect as an alternative to the IM, in addition to bone grafting. METHODS Thirty-six 12-week-old female Sprague-Dawley rats were used. After creating a 5-mm long bone defect in the femur, a mixture of autologous and artificial bone was grafted into the defect, and a saphenous arteriovenous vascular bundle was introduced. The animals were divided into three groups: the control group (bone defect only), the BG group (bone grafting only), and the BG + V group (bone grafting + vascular bundle introduction). After surgery, radiological and histological evaluations were performed to assess osteogenesis and angiogenesis in bone defects. RESULTS In the BG + V group, significant bone formation was observed in the bone defect on radiological and histological evaluations, and the amount of bone formation was significantly higher than that in the other two groups. Furthermore, cortical bone continuity was observed in many specimens in the BG + V group. On histological evaluation, the number of blood vessels was also significantly higher in the BG + V group than in the other two groups. CONCLUSION Our results suggest that the introduction of a vascular bundle in addition to bone grafting can promote bone formation in bone defects and allow for complete bone defect reconstruction in a single surgery.
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Affiliation(s)
- Kunihiko Oka
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Yoshio Kaji
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Osamu Nakamura
- Department of Orthopedic Surgery, Kagawa Prefectural Shirotori Hospital, Higashikagawa City, Kagawa, Japan
| | - Konosuke Yamaguchi
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Sachiko Tobiume
- Department of Orthopedic Surgery, Shikoku Medical Center for Children and Adults, Zentsuji City, Kagawa, Kagawa, Japan
| | - Yumi Nomura
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Tetsuji Yamamoto
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
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Roberts DC, Jose RM, Duraku LS, Wordsworth M, Foster M, Mortiboy D, Sellon E, Stapley SA, Power DM. Management of conflict injuries to the upper limb. Part 2: reconstruction and managing complications. J Hand Surg Eur Vol 2022; 47:787-797. [PMID: 35701990 DOI: 10.1177/17531934221105225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This is the second of a two-part review article on the management of conflict injuries, focused on the reconstructive strategies for bone, nerve and soft tissue and to provide guidance on assessing and managing common complications associated with complex upper limb injuries. Following assessment and early surgical management, the conflict casualty will require further wound evaluation and planning prior to definitive reconstruction of limb injuries. Surgical management of the upper limb injury should aim, where possible, to preserve the limb and allow functional reconstruction. The principles of the second look procedure are to assess wound progression, further reduce the risk of infection and plan definitive reconstruction with adequate soft tissue cover. The prerequisites for successful surgical reconstruction are a stable patient, combined orthoplastic surgery expertise supported by physiotherapists and hand therapists.
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Affiliation(s)
- Darren C Roberts
- Queen Alexandra Hospital Hand Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Rajive M Jose
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Liron S Duraku
- The Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Matthew Wordsworth
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Foster
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Deborah Mortiboy
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Edward Sellon
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah A Stapley
- Queen Alexandra Hospital Hand Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dominic M Power
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Induced Membrane Technique for the Treatment of Infected Forearm Nonunion: A Retrospective Study. J Hand Surg Am 2022; 47:583.e1-583.e9. [PMID: 34563414 DOI: 10.1016/j.jhsa.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Infected forearm nonunion remains a challenge for the hand surgeon. Autologous bone grafting within an induced membrane following implantation of a cement spacer, also known as the Masquelet technique, is a procedure used for addressing segmental bone defects. This report summarized our experience using this technique to treat the infected forearm nonunion. METHODS We retrospectively reviewed a series of 32 patients treated for infected forearm nonunion by the 2-stage Masquelet technique between 2009 and 2018. There was an infected nonunion of the ulna in 28 patients and an infected nonunion of the radius in 4 patients. All patients had undergone an average of 2.7 procedures before presenting at our institution. Treatment involved a staged procedure in which an antibiotic-impregnated cement spacer was implanted into the bone defect following debridement without internal fixation. It was left in place for 4-6 weeks, during which time a membrane formed around the cement spacer. In the second stage, the induced membrane was incised, and the cement spacer was removed. The defect was then filled with cancellous autograft with the addition of internal fixation. Postoperative radiographs were taken for the evaluation of bone healing. The functional results of the affected forearm were evaluated for motion loss of elbow or wrist and rotation loss of forearm. RESULTS All nonunions healed without recurrent infection or loosening of internal fixation at the time of final follow-up. All the patients showed substantial functional improvement, with excellent results in 14 patients, satisfactory results in 13, and unsatisfactory results in 5. CONCLUSIONS The induced membrane technique is an effective solution for infected forearm nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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O’Connor CM, Perloff E, Drinane J, Cole K, Marinello PG. An Analysis of Complications and Bone Defect Length With the Use of Induced Membrane Technique in the Upper Limb: A Systematic Review. Hand (N Y) 2022; 17:572-577. [PMID: 32666849 PMCID: PMC9112749 DOI: 10.1177/1558944720918368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: The induced membrane technique was originally described as a technique for the reconstruction of long bone defects. The authors performed a systematic review to determine whether the use of the induced membrane technique is effective in large bony defects in the upper extremity. Methods: A qualitative systematic review was conducted using PubMed, EBSCO, and Google Scholar databases to record all studies reporting on complications of the induced membrane technique in the upper extremity. Studies written after 1990 in English language journals met the inclusion criteria. Exclusion criteria were non-English language publications, animal studies, failure to identify the location of the bone defect, failure to identify whether complications were associated with the procedure, and failure to define the length of bone defect. Results: A total of 1422 studies were identified in the original search. Twelve studies satisfied the criteria for inclusion. A total of 70 patients with 83 upper extremity cases were reported: 1 proximal interphalangeal joint, 22 phalanges, 8 metacarpals, 37 forearms, 14 humeri, and 1 clavicle. The mean bone defect size was 4.0 cm (SD, 1.5). The most common complication was infection. We found that complication rates were independent of the location of the bone defect. Complication rates in the upper extremity ranged from 0% to 100%, with a total weighted mean of 10%. Conclusion: The induced membrane technique is an emerging possible treatment of large bone defects in the upper extremity. More research is needed to determine the outcomes of the induced membrane technique in the upper extremity.
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Affiliation(s)
- Casey M. O’Connor
- Albany Medical Center, NY, USA,Casey M. O’Connor, Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Road, Albany, NY 12208, USA.
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Outcomes After Use of the Induced Membrane Technique for Fractures of the Upper Extremity. J Hand Surg Am 2022:S0363-5023(22)00058-2. [PMID: 35304008 DOI: 10.1016/j.jhsa.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/17/2021] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to review a series of cases in which the induced membrane technique was used for fractures with segmental bone loss in the upper extremity. We aimed to examine patient indications, outcomes based on union rates, and complications associated with this technique. METHODS An institutional review board-approved database at our institution was used to identify patients based on either diagnosis or procedure codes commonly used during the induced membrane treatment. The database was queried between 2003 and 2020 and included patients with segmental bone defects from acute trauma, nonunions, and infections. Demographic data, mechanism of injury, size and extent of the bone defect, treatment indication and methods along with intraoperative and postoperative complications were retrospectively reviewed. RESULTS We identified 23 patients who met our inclusion criteria, including 15 patients with traumatic segmental bone loss and 8 patients with chronic nonunions and/or infections. Fourteen cases involving the bones of the forearm, 8 cases involving the metacarpals and 3 cases involving the phalanges were identified. Radiographic union was ultimately demonstrated in 21/23 patients (91.3%) with a median time to union of 20 weeks (range 13-29 weeks). A total of 10 patients required unplanned reoperation, with 4 nonunions requiring repeat plating and grafting procedures, and 1 patient ultimately underwent amputation for persistent infection. CONCLUSIONS The induced membrane technique represents an effective treatment option for acute traumatic bone loss as well as chronic fracture nonunions. The technique has potential challenges, as 10 patients (43.5%) in our series required unplanned reoperations with 4 patients (17.4%) requiring a repeat intervention for persistent nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE THERAPEUTIC IV.
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Masquelet technique for infected distal radius fractures with gaps in paediatric age group. Trauma Case Rep 2022; 37:100568. [PMID: 34977319 PMCID: PMC8683642 DOI: 10.1016/j.tcr.2021.100568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 11/23/2022] Open
Abstract
The management of infected nonunion with bone loss is always challenging. The Masquelet technique is an excellent option available for us today. However, there are few reports of its use in the paediatric age group and no reports of its use especially in infected distal radius fractures or nonunion. We report on two children with infection and significant bone loss after open fractures of the distal radius which we have treated successfully using a modified Masquelet technique.
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Commeil P, Seguineau A, Delesque A, Erbland A, Harly E, Lecoanet P, Fabre T, Dunet B. Post-traumatic forearm bone defect reconstruction using the induced membrane technique. Orthop Traumatol Surg Res 2021; 107:103036. [PMID: 34365022 DOI: 10.1016/j.otsr.2021.103036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/27/2020] [Accepted: 02/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The induced membrane technique, first described by Masquelet, is now well standardized, but little studied in post-traumatic forearm bone defect. The main aim of the present study was to analyze consolidation rates in this indication. The study hypothesis was that the induced membrane technique provides good consolidation results. METHODS We performed a retrospective assessment of our experience with 10 cases of induced membrane forearm reconstruction. The two main etiologies were acute trauma or treatment for non-union. Functional impact was assessed on range of motion and QuickDASH. The complications rate was also examined. RESULTS There were 3 cases of post-traumatic bone defect, and 7 of non-union treatment, including 6 septic non-unions. Mean defect size was 4.3cm. Mean interval between induced membrane stages 1 and 2 was 3.3 months. Pure cancellous iliac bone graft was systematic. Nine of the patients showed consolidation, at a mean 9.2 months; there was 1 case of non-consolidation, but no other complications. Range of motion was satisfactory; mean QuickDASH score was 22 at a mean 50.3 months' follow-up. CONCLUSION The induced membrane technique was reliable, reproducible and technically accessible, with good functional and radiographic results and few complications. LEVEL OF EVIDENCE IV; retrospective study without control group.
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Affiliation(s)
- Paul Commeil
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France.
| | - Arthur Seguineau
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France
| | - Alison Delesque
- Service de chirurgie orthopédique et traumatologique, centre hospitalier Libourne, 112, rue de la Marne, 35000 Libourne cedex, France
| | - Alexandra Erbland
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France
| | - Edouard Harly
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France
| | - Paul Lecoanet
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier Libourne, 112, rue de la Marne, 35000 Libourne cedex, France
| | - Thierry Fabre
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France
| | - Bertrand Dunet
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier Libourne, 112, rue de la Marne, 35000 Libourne cedex, France
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Dalisson B, Charbonnier B, Aoude A, Gilardino M, Harvey E, Makhoul N, Barralet J. Skeletal regeneration for segmental bone loss: Vascularised grafts, analogues and surrogates. Acta Biomater 2021; 136:37-55. [PMID: 34626818 DOI: 10.1016/j.actbio.2021.09.053] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 02/08/2023]
Abstract
Massive segmental bone defects (SBD) are mostly treated by removing the fibula and transplanting it complete with blood supply. While revolutionary 50 years ago, this remains the standard treatment. This review considers different strategies to repair SBD and emerging potential replacements for this highly invasive procedure. Prior to the technical breakthrough of microsurgery, researchers in the 1960s and 1970s had begun to make considerable progress in developing non autologous routes to repairing SBD. While the breaktthrough of vascularised bone transplantation solved the immediate problem of a lack of reliable repair strategies, much of their prior work is still relevant today. We challenge the assumption that mimicry is necessary or likely to be successful and instead point to the utility of quite crude (from a materials technology perspective), approaches. Together there are quite compelling indications that the body can regenerate entire bone segments with few or no exogenous factors. This is important, as there is a limit to how expensive a bone repair can be and still be widely available to all patients since cost restraints within healthcare systems are not likely to diminish in the near future. STATEMENT OF SIGNIFICANCE: This review is significant because it is a multidisciplinary view of several surgeons and scientists as to what is driving improvement in segmental bone defect repair, why many approaches to date have not succeeded and why some quite basic approaches can be as effective as they are. While there are many reviews of the literature of grafting and bone repair the relative lack of substantial improvement and slow rate of progress in clinical translation is often overlooked and we seek to challenge the reader to consider the issue more broadly.
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Induced membrane technique applied to the forearm: Technical refinement, indications and results of 13 cases. Orthop Traumatol Surg Res 2021; 107:103074. [PMID: 34563733 DOI: 10.1016/j.otsr.2021.103074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 02/23/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The unique anatomical characteristics of the forearm bones makes their reconstruction challenging. The aim of this study was to report the surgical methods and results of the induced membrane technique applied to traumatic forearm bone defects. MATERIAL AND METHODS We evaluated retrospectively a case series of 13 patients operated between 2010 and 2017. The first surgical step consisted of debridement of the fracture site and implantation of a cement spacer with appropriate fixation. The anatomy of the forearm skeleton had to be restored. The second step, done 6 weeks later, consisted of removing the cement spacer and applying cancellous bone autograft harvested from the iliac crest. The outcome measures were radiological bone union, need for surgical revision, and postoperative wrist range of motion. RESULTS All 13 patients were men, with a mean age of 39 years (18-67). The average follow-up was 2.5 years. Eleven patients were suffering from a nonunion and two from a post-traumatic bone defect. Six patients had an identified preoperative infection. Three patients had previously undergone an unsuccessful treatment for their nonunion with bone addition. The maximum length of bone reconstruction was 12 cm. Union was achieved in 12 of 13 patients in a mean of 5 months (3-8). The other patient died during the postoperative course. Two patients needed revision surgery: ulnar shortening osteotomy (1 case) and additional tendon reconstruction (1 case). The mean pronosupination range was 123° on average (55-180°). The mean flexion-extension range was 106° (90-130°). CONCLUSION The induced membrane technique is a reliable reconstruction technique that is well suited to reconstruction of the forearm skeleton. LEVEL OF EVIDENCE IV, retrospective study.
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Pachera G, Santolini E, Galuppi A, Dapelo E, Demontis G, Formica M, Santolini F, Briano S. Forearm segmental bone defect: Successful management using the Masquelet Technique with the aid of 3D printing technology. Trauma Case Rep 2021; 36:100549. [PMID: 34765716 PMCID: PMC8569702 DOI: 10.1016/j.tcr.2021.100549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/23/2021] [Indexed: 11/30/2022] Open
Abstract
The management of forearm nonunion is challenging for orthopaedic surgeons because the forearm is a unique anatomical segment in which all the bones and structures involved embody a complex functional unit. Therefore, when treating such a complex condition, the surgeon must focus not only on bone healing but also on the restoration of the native anatomy in order to replicate the normal relationship between the bones and all the surrounding structures and thus the full function of the forearm, the elbow and the wrist. Here we report the case of a 53-year-old patient with a left forearm deformity due to an atrophic nonunion of the ulna and a malunion of the radius, which was successfully managed with the use of the Masquelet technique associated with a corrective osteotomy of the radius, performed with the aid of a 3D model.
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Affiliation(s)
- Giulia Pachera
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emmanuele Santolini
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Galuppi
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emanuela Dapelo
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giacomo Demontis
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Formica
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Santolini
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Briano
- Orthopedics and Trauma Unit, Emergency Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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A case report of extensive segmental defect of the humerus due to thermal necrosis treated with Masquelet technique. Trauma Case Rep 2021; 36:100544. [PMID: 34746355 PMCID: PMC8554246 DOI: 10.1016/j.tcr.2021.100544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 10/13/2021] [Indexed: 11/24/2022] Open
Abstract
Thermal necrosis due to over-reaming or blunt reamer may have devastating consequences. We present one such case of humerus shaft fracture referred to us at two and half months after primary surgery with active signs of infection and sequestrated segment of the humerus. The challenges were not only to achieve union, control of infection, but also the 10 cm bone gap created after removal of sequestrated part of humerus and preservation of reasonable function of adjacent joints. Emergency drainage of thick purulent material was done on day one because the patient was in excessive pain, the abscess was likely to burst and she was unfit for major surgery due to her toxic clinical state abnormal blood parameters. We had managed this case successfully using Masquelet technique. Masquelet technique is an excellent option for bone gap reconstruction compared to other techniques. It helped us to achieve good functional outcomes and to manage large bone loss in infected humeral non-union.
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Contreras JJ, Díaz A, Beltrán M. Extensive humeral defect secondary to humeral shaft nonunion and chronic osteomyelitis treated with induced membrane technique augmented with fibula autograft: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:446-456. [PMID: 37588721 PMCID: PMC10426561 DOI: 10.1016/j.xrrt.2021.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Julio J. Contreras
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
- Shoulder and Elbow Unit, Pontifical Catholic University of Chile, Santiago, Chile
- Department of Orthopedics and Trauma, Pontifical Catholic University of Chile, Santiago, Chile
| | - Alonso Díaz
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
| | - Manuel Beltrán
- Shoulder and Elbow Unit, Instituto Traumatológico, Santiago, Chile
- Department of Orthopedics and Trauma, Universidad de Chile, Santiago, Chile
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Abstract
OBJECTIVES To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome. DESIGN Multicenter retrospective review. SETTING Nine Level 1 Trauma Centers. PATIENTS/PARTICIPANTS One hundred sixty-eight patients had 198 radius and ulna fractures due to firearm injuries. All patients were adults, had a fracture due to a firearm injury, and at least 1-year clinical follow-up or follow-up until union. The average follow-up was 831 days. INTERVENTION Most patients (91%) received antibiotics. Formal irrigation and debridement in the operating room was performed in 75% of cases along with either internal fixation (75%), external fixation (6%), or I&D without fixation (19%). MAIN OUTCOME MEASURES Complications including neurovascular injuries, compartment syndrome, infection, and nonunion. RESULTS Twenty-one percent of patients had arterial injuries, and 40% had nerve injuries. Nine patients (5%) developed compartment syndrome. Seventeen patients (10%) developed infections, all in comminuted or segmental fractures. Antibiotics were not associated with a decreased risk of infection. Infections in the ulna were more common in fractures with retained bullet fragments and bone loss. Twenty patients (12%) developed a nonunion. Nonunions were associated with high velocity firearms and bone defect size. CONCLUSIONS Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Toros T, Ozaksar K. Reconstruction of traumatic tubular bone defects using vascularized fibular graft. Injury 2021; 52:2926-2934. [PMID: 31455503 DOI: 10.1016/j.injury.2019.08.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/10/2019] [Indexed: 02/02/2023]
Abstract
Large segmental bone defects due to major trauma constitute a major challenge for the orthopaedic surgeon, especially when combined with poor or lost soft tissue envelope. Vascularized fibular transfer is considered as the gold standard for the reconstruction of such defects of the extremities due to its predictable vascular pedicle, long cylindrical shape, and tendency to hypertrophy, and resistance to infection. Vascularized bone grafts remain viable throughout the healing period and are capable of inducing rapid graft union without prolonged creeping substitution, osteogenesis and hypertrophy at the reconstruction site, and fight with infection. The fibular graft can be transferred solely, or as a composite flap including muscle, subcutaneous tissue, skin and even a nerve segment in order to reconstruct both bone and soft tissue components of the injury at single stage operation. Such a reconstruction can even be performed in the presence of local infection, since vascularized bone and adjacent soft tissue components enhances the blood flow at the traumatized zone, allowing for the delivery of antibiotics and immune components to the infection site. In an effort to preserve growth potential in pediatric patients; the fibular head and proximal growth plate can be included to the graft. This practice also enables to reconstruct the articular ends of various bones, including distal radius and proximal ulna. Apart from defect reconstruction, vascularized fibular grafts also proved to be a reliable in treating atrophic nonunions, reconstruction of osteomyelitic bone segments. These grafts are superior to alternative reconstructive techniques, as bone grafts with intrinsic blood supply lead to higher success rates in reconstruction and accelerate the repair process at the injury site in cases where blood supply to the injury zone is defective, poor soft tissue envelope, and local infection at the trauma zone.
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Affiliation(s)
- Tulgar Toros
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, 1418 Sok. No: 14 Kahramanlar, 35230 Izmir, Turkey.
| | - Kemal Ozaksar
- Hand and Microsurgery & Orthopedics and Traumatology (EMOT) Hospital, 1418 Sok. No: 14 Kahramanlar, 35230 Izmir, Turkey
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Ferreira N, Saini AK, Birkholtz FF, Laubscher M. Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:911-922. [PMID: 33674937 DOI: 10.1007/s00590-021-02887-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Injuries to the long bones of the upper limb resulting in bone defects are rare but potentially devastating. Literature on the management of these injuries is limited to case reports and small case series. The aim of this study was to collate the most recent published work on the management of upper limb bone defects to assist with evidence based management when confronted with these cases. METHODS Following a preliminary search that confirmed the paucity of literature and lack of comparative trials, a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of upper limb long bone defects published between 2010 and 2020. RESULTS A total of 46 publications reporting on the management of 341 patients were reviewed. Structural autograft, bone transport, one-bone forearm and the induced membrane technique were employed in an almost equal number of cases. The implemented strategies showed similar outcomes but different indications and complication profiles were observed. CONCLUSION Contemporary techniques for the management of post-traumatic upper limb bone defects all produce good results. Specific advantages, disadvantages and complications for each modality should be considered when deciding on which management strategy to employ for each specific patient, anatomical location, and defect size.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa.
| | - Aaron Kumar Saini
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
| | - Franz Friedrich Birkholtz
- Walk-A-Mile Centre and Department of Orthopaedics, University of Pretoria, Pretoria, 0002, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Department of Surgery, University of Cape Town, Cape Town, 7505, South Africa
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Liu Y, Yushan M, Liu Z, Liu J, Ma C, Yusufu A. Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique. BMC Musculoskelet Disord 2021; 22:36. [PMID: 33413259 PMCID: PMC7789280 DOI: 10.1186/s12891-020-03896-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.
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Affiliation(s)
- Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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22
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Inui A, Mifune Y, Nishimoto H, Niikura T, Kuroda R. Reconstruction of Carpal Bone Loss of Septic Wrist Arthritis Using Induced Membrane Technique. J Hand Microsurg 2020; 12:S54-S57. [PMID: 33335373 PMCID: PMC7735540 DOI: 10.1055/s-0039-1680278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The induced membrane technique has been widely used for the reconstruction of the segmental bone defect. The technique requires two-stage surgery. The first surgery is debridement of the affected bone and replacement of the defect by cement spacer. The spacer is removed at the second surgery, and the defect is filled with cancellous bone. The use of the technique for septic wrist arthritis treatment has not been reported. We report two cases of septic wrist arthritis treated by the induced membrane technique. Radical debridement including the carpal bones was performed as a first surgery. The cement spacer was placed into the bone defect after first surgery; then cancellous bone was transplanted into the induced membrane several weeks later. External fixator or plate fixation was performed simultaneously. Bone formation was observed in both cases at several months after the reconstruction surgery. There was no pain or recurrence of infection in both cases. We consider this technique is a possible method for reconstruction, especially in a difficult case.
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Affiliation(s)
- Atsuyuki Inui
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yutaka Mifune
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hanako Nishimoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takahiro Niikura
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Dilogo IH, Rahmatika D, Pawitan JA, Liem IK, Kurniawati T, Kispa T, Mujadid F. Allogeneic umbilical cord-derived mesenchymal stem cells for treating critical-sized bone defects: a translational study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:265-273. [PMID: 32804289 DOI: 10.1007/s00590-020-02765-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/05/2020] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The current 'gold-standard' treatment of critical-sized bone defects (CSBDs) is autografts; however, they have drawbacks including lack of massive bone source donor site morbidity, incomplete remodeling, and the risk of infection. One potential treatment for treating CSBDs is bone marrow-derived mesenchymal stem cells (BM-MSCs). Previously, there were no studies regarding the use of human umbilical cord-mesenchymal stem cells (hUC-MSCs) for treating BDs. We aim to investigate the use of allogeneic hUC-MSCs for treating CSBDs. METHOD We included subjects who were diagnosed with non-union fracture with CSBDs who agreed to undergo hUC-MSCs implantation. All patients were given allogeneic hUC-MSCs. All MSCs were obtained and cultured using the multiple-harvest explant method. Subjects were evaluated functionally using the Lower Extremity Functional Scale (LEFS) and radiologically by volume defect reduction. RESULT A total of seven (3 male, 4 female) subjects were recruited for this study. The subjects age ranged from 14 to 62 years. All seven subjects had increased LEFS during the end of the follow-up period, indicating improved functional ability. The follow-up period ranged from 12 to 36 months. One subject had wound dehiscence and infection, and two subjects developed partial union. CONCLUSION Umbilical cord mesenchymal stem cells are a potential new treatment for CSBDs. Additional studies with larger samples and control groups are required to further investigate the safety and efficacy of umbilical cord-derived mesenchymal stem cells for treating CSBDs.
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Affiliation(s)
- Ismail Hadisoebroto Dilogo
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, CMU 2 Building 5th Floor, Jl. Diponegoro 71, Jakarta Pusat, Indonesia.
- Stem Cell and Tissue Engineering Research Center, IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Dina Rahmatika
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, CMU 2 Building 5th Floor, Jl. Diponegoro 71, Jakarta Pusat, Indonesia
| | - Jeanne Adiwinata Pawitan
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, CMU 2 Building 5th Floor, Jl. Diponegoro 71, Jakarta Pusat, Indonesia
- Department Histology, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, Indonesia
- Stem Cell and Tissue Engineering Research Center, IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Isabella Kurnia Liem
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, CMU 2 Building 5th Floor, Jl. Diponegoro 71, Jakarta Pusat, Indonesia
- Stem Cell and Tissue Engineering Research Center, IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Department of Anatomy, Faculty of Medicine, Universitas Indonesia, Jl. Salemba 6, Jakarta, Indonesia
| | - Tri Kurniawati
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, CMU 2 Building 5th Floor, Jl. Diponegoro 71, Jakarta Pusat, Indonesia
- Stem Cell and Tissue Engineering Research Center, IMERI, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tera Kispa
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, CMU 2 Building 5th Floor, Jl. Diponegoro 71, Jakarta Pusat, Indonesia
| | - Fajar Mujadid
- Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo Central Hospital, Faculty of Medicine, Universitas Indonesia, CMU 2 Building 5th Floor, Jl. Diponegoro 71, Jakarta Pusat, Indonesia
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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. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e1900179. [PMID: 32672724 PMCID: PMC7366422 DOI: 10.5435/jaaosglobal-d-19-00179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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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Carroll JJ, Henderson C, Watson J, Larsen K, Kobayashi K. Interposition Arthroplasty of the Elbow After Proximal Ulna Reconstruction With the Masquelet Technique: A Case Report. JBJS Case Connect 2020; 10:e0084. [PMID: 32649104 DOI: 10.2106/jbjs.cc.19.00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Periarticular bone loss in the upper extremity poses challenges for a functional reconstruction. CASE A 32-year-old man sustained an open elbow fracture-dislocation from a high-velocity gunshot resulting in significant bone and soft-tissue loss about the proximal ulna. He underwent bony reconstruction with the Masquelet technique and delayed interposition arthroplasty in an attempt to preserve function. CONCLUSIONS The Masquelet technique, coupled with interposition arthroplasty, may be used to address significant articular bony defects about the proximal ulna, allowing patients to maintain function and limit pain.
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Affiliation(s)
- John J Carroll
- Department of Orthopaedic Surgery, Brooke Army Medical Center, Ft. Sam Houston, Texas
| | - Chance Henderson
- Department of Orthopaedic Surgery, United States Air Force Academy, Colorado Springs, Colorado
| | - Jeff Watson
- Colorado Springs Orthopaedic Group, Colorado Springs, Colorado
| | - Karl Larsen
- Colorado Center of Orthopaedic Excellence, Colorado Springs, Colorado
| | - Ky Kobayashi
- Colorado Center of Orthopaedic Excellence, Colorado Springs, Colorado
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A case report of extensive segmental defect of the humerus treated with Masquelet technique. J Shoulder Elbow Surg 2020; 29:1368-1374. [PMID: 32553437 DOI: 10.1016/j.jse.2020.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 02/01/2023]
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Pruzansky ME, Lee Y, Pruzansky J. Masquelet Technique for Phalangeal Reconstruction and Osteomyelitis. Tech Hand Up Extrem Surg 2020; 25:52-55. [PMID: 32555013 DOI: 10.1097/bth.0000000000000299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Osteomyelitis of the finger presents a challenging problem. Although there are multiple treatments described in the literature, the infection often results in eventual amputation. The authors present a case of an open fracture of the index finger complicated by nonunion, infection, and osteomyelitis. This was successfully treated by the placement of an antibiotic cement spacer and subsequent reconstruction with iliac crest bone graft, after the 2-stage Masquelet technique, using intravenous and oral antibiotics. They show that this technique, although infrequently described in the hand and fingers, can be a successful option for the treatment of phalangeal osteomyelitis and phalangeal reconstruction.
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Affiliation(s)
- Mark E Pruzansky
- HandSport Surgery Institute, New York, NY
- Department of Orthopaedics, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY
| | - Yunsoo Lee
- Department of Orthopaedics, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY
| | - Jason Pruzansky
- HandSport Surgery Institute, New York, NY
- Department of Orthopaedics, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY
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[The wrapping induced membrane technique for treating recalcitrant non unions]. ANN CHIR PLAST ESTH 2020; 65:320-325. [PMID: 32430139 DOI: 10.1016/j.anplas.2020.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/27/2020] [Indexed: 11/20/2022]
Abstract
The induced membrane technique is now well accepted for reconstruction of segmental bone defect. On the other hand, some cases of aseptic non-union are unsuccessfully treated by several surgical attempts for obtaining bone healing. The two stages wrapping induced membrane technique was developed initially for treating atrophic and recalcitrant aseptic non union without bone loss. At the first stage, the site of non-union was firmly fixed and tiles of cement were placed close to the bone on two or three aspects of the bone. At the second stage, after removing the spacers, the induced cavities were filled with cancellous bone autograft. In the two reported cases bone healing was acquired in 4 months. One case was a recalcitrant atrophic non-union of the humeral shaft, the other case concerned the enhancement of an insufficient segmental reconstruction of the femur. The follow up were respectively 3 years and 2 years without complication. The membrane induced by the cement tiles prevents the bone graft resorption and improves the osteogenicity through its biological properties.
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Abstract
An infected diaphyseal forearm nonunion can be a challenge. After several failed salvage procedures, the patient can be left with residual pain, shortening, bone loss, and poor soft tissue envelope. Keystones for infected nonunion treatment are debridement, cultures, antibiotics, stability, and restore alignment. This report describes the current literature on the treatment of forearm nonunion, and we present a case of a recalcitrant infected ulna nonunion that ultimately healed after 12 surgeries.
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Affiliation(s)
- Niels Bech
- Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, NLD
| | - Peter Kloen
- Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, NLD
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30
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Preston NLP, Black TE, Thomas RC. Reconstruction of a Traumatic Partial First-Ray Amputation with the Use of an Induced Pseudosynovial Membrane and Corticocancellous Autograft. J Am Podiatr Med Assoc 2020; 110:436392. [PMID: 32556233 DOI: 10.7547/18-019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Reconstruction of large bone defects of the metatarsals, whether resulting from trauma, infection, or a neoplastic process, can be especially challenging when attempting to maintain an anatomical parabola and basic biomechanical stability of the forefoot. We present the case of a 42-year-old man with no significant medical history who presented to the emergency department following a severe lawnmower injury to the left forefoot resulting in a large degloving type injury along the medial aspect of the left first ray extending to the level of the medial malleolus. The patient underwent emergent debridement with application of antibiotic bone cement, external fixation, and a negative-pressure dressing. He was subsequently treated with split-thickness skin graft and iliac crest tricortical autograft using a locking plate construct for reconstruction of the distal first ray. Although the patient failed to advance to radiographic osseous union, clinically there was no motion at the attempted fusion site and no pain with ambulation, suggestive of a pseudoarthrosis. The patient has since progressed to full nonpainful weightbearing in regular shoes and has returned to normal activities of daily living. The patient returned to his preinjury level of work and has had complete resolution of all wounds including his split-thickness skin graft donor site. This case shows the potential efficacy of the Masquelet technique for spanning significant traumatic bone defects of the metatarsals involving complete loss of the metatarsophalangeal joint.
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Affiliation(s)
| | - Trevor E Black
- Grant Medical Center Foot and Ankle Surgery Residency Program, Columbus, OH.,Southeast Permanente Foot and Ankle Trauma and Reconstructive Fellowship, Atlanta, GA
| | - Randall C Thomas
- Grant Medical Center Foot and Ankle Surgery Residency Program, Columbus, OH.,Private practice, Clintonville Foot and Ankle, Columbus, OH
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Miller EA, Iannuzzi NP, Kennedy SA. Management of the Mangled Upper Extremity: A Critical Analysis Review. JBJS Rev 2019; 6:e11. [PMID: 29688909 DOI: 10.2106/jbjs.rvw.17.00131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Erin A Miller
- Division of Plastic Surgery, Department of Surgery (E.A.M.), and Department of Orthopaedics and Sports Medicine (N.P.I. and S.A.K.), University of Washington, Seattle, Washington
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Staged arthrodesis using the Masquelet technique for osteomyelitis of the finger with articular destruction: a report of two cases. Arch Orthop Trauma Surg 2019; 139:1025-1031. [PMID: 31093754 DOI: 10.1007/s00402-019-03197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Indexed: 02/09/2023]
Abstract
Osteitis of the fingers is a serious infection that needs early diagnosis and appropriate surgical debridement and antibiotic treatment of the infected bone. If the effects of treatments are insufficient, long-term antibiotic treatment and repeated operations could be required. In worst cases, some patients may have to undergo amputation. Recently, the usefulness of the Masquelet technique in extensive traumatic bone defects has been reported. We herein describe two cases of immunocompromised patients with purulent osteitis involving joint destruction of the finger treated by two-stage arthrodesis using the Masquelet technique. They obtained good infection control and better function of the finger than before the operation. Moreover, there was no recurrence of the infection. The Masquelet technique could be an alternative technique for osteitis with high risk of amputation.
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Masquelet A, Kanakaris NK, Obert L, Stafford P, Giannoudis PV. Bone Repair Using the Masquelet Technique. J Bone Joint Surg Am 2019; 101:1024-1036. [PMID: 31169581 DOI: 10.2106/jbjs.18.00842] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Alain Masquelet
- Department of Orthopaedic Surgery, Avicenne Hospital, Bobiny, France
| | - Nikolaos K Kanakaris
- Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom
| | - Laurent Obert
- Traumatology, Reconstructive, and Plastic Surgery Unit, CHU Jean Minjoz, Besançon, France
| | - Paul Stafford
- Orthopedic Trauma Surgery of Oklahoma, Tulsa, Oklahoma
| | - Peter V Giannoudis
- Major Trauma Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, United Kingdom.,Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, United Kingdom
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Walker M, Sharareh B, Mitchell SA. Masquelet Reconstruction for Posttraumatic Segmental Bone Defects in the Forearm. J Hand Surg Am 2019; 44:342.e1-342.e8. [PMID: 30146386 DOI: 10.1016/j.jhsa.2018.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 05/28/2018] [Accepted: 07/13/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The Masquelet technique is a procedure increasingly utilized for addressing segmental bone defects. The technique involves staged procedures consisting of bone debridement and temporary spacer placement to induce membrane formation, followed by delayed bone grafting. This report summarizes our center's experience with the Masquelet technique to reconstruct bone loss exclusively in the forearm. METHODS We reviewed all cases in which the Masquelet technique was used to reconstruct segmental bone defects in the forearm resulting from acute trauma or nonunion, with or without infection, between 2014 and 2017 at a level-1 trauma center. Injury mechanism, prior surgeries, extent of bone defect, and demographic data were collected. Union was assessed along with treatment-related complications or reoperations. RESULTS We identified 9 patients with segmental bony defects in the forearm treated with the Masquelet technique. Among this cohort, 5 patients had bone defects associated with acute open fractures and 4 patients presented with nonunion (1 atrophic and 3 infected nonunions). The median bony defect was 4.7 cm (range, 1.7-5.4 cm) at the time of grafting. Second stage grafting was performed with Reamer Irrigator Aspirator autograft from the femur in 8 patients and iliac crest bone cancellous graft in 1 patient. Union was achieved in all 9 patients. Six patients achieved union by 3-month follow-up, 2 patients by 6 months, and 1 patient by 12 months. One patient required a reoperation for plate fracture prior to union treated with revision internal fixation and grafting. CONCLUSIONS The Masquelet technique effectively reconstructed traumatic and posttraumatic segmental defects in the forearm with a low incidence of complication. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Matthew Walker
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
| | - Behnam Sharareh
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX.
| | - Scott A Mitchell
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
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Grgurevic L, Oppermann H, Pecin M, Erjavec I, Capak H, Pauk M, Karlovic S, Kufner V, Lipar M, Bubic Spoljar J, Bordukalo-Niksic T, Maticic D, Peric M, Windhager R, Sampath TK, Vukicevic S. Recombinant Human Bone Morphogenetic Protein 6 Delivered Within Autologous Blood Coagulum Restores Critical Size Segmental Defects of Ulna in Rabbits. JBMR Plus 2018; 3:e10085. [PMID: 31131338 DOI: 10.1002/jbm4.10085] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/29/2018] [Accepted: 12/16/2018] [Indexed: 12/21/2022] Open
Abstract
BMP2 and BMP7, which use bovine Achilles tendon-derived absorbable collagen sponge and bovine bone collagen as scaffold, respectively, have been approved as bone graft substitutes for orthopedic and dental indications. Here, we describe an osteoinductive autologous bone graft substitute (ABGS) that contains recombinant human BMP6 (rhBMP6) dispersed within autologous blood coagulum (ABC) scaffold. The ABGS is created as an injectable or implantable coagulum gel with rhBMP6 binding tightly to plasma proteins within fibrin meshwork, as examined by dot-blot assays, and is released slowly as an intact protein over 6 to 8 days, as assessed by ELISA. The biological activity of ABGS was examined in vivo in rats (Rattus norvegicus) and rabbits (Oryctolagus cuniculus). In a rat subcutaneous implant assay, ABGS induced endochondral bone formation, as observed by histology and micro-CT analyses. In the rabbit ulna segmental defect model, a reproducible and robust bone formation with complete bridging and restoration of the defect was observed, which is dose dependent, as determined by radiographs, micro-CT, and histological analyses. In ABGS, ABC scaffold provides a permissive environment for bone induction and contributes to the use of lower doses of rhBMP6 compared with BMP7 in bovine bone collagen as scaffold. The newly formed bone undergoes remodeling and establishes cortices uniformly that is restricted to implant site by bridging with host bone. In summary, ABC carrier containing rhBMP6 may serve as an osteoinductive autologous bone graft substitute for several orthopedic applications that include delayed and nonunion fractures, anterior and posterior lumbar interbody fusion, trauma, and nonunions associated with neurofibromatosis type I.
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Affiliation(s)
- Lovorka Grgurevic
- Laboratory for Mineralized Tissues School of Medicine University of Zagreb Zagreb Croatia
| | | | - Marko Pecin
- Clinics for Surgery, Orthopedics, and Ophthalmology School of Veterinary Medicine University of Zagreb Zagreb Croatia
| | - Igor Erjavec
- Laboratory for Mineralized Tissues School of Medicine University of Zagreb Zagreb Croatia
| | - Hrvoje Capak
- Department of Radiology School of Veterinary Medicine University of Zagreb Zagreb Croatia
| | - Martina Pauk
- Laboratory for Mineralized Tissues School of Medicine University of Zagreb Zagreb Croatia
| | - Sven Karlovic
- Faculty of Food Technology and Biotechnology University of Zagreb Zagreb Croatia
| | - Vera Kufner
- Laboratory for Mineralized Tissues School of Medicine University of Zagreb Zagreb Croatia
| | - Marija Lipar
- Clinics for Surgery, Orthopedics, and Ophthalmology School of Veterinary Medicine University of Zagreb Zagreb Croatia
| | - Jadranka Bubic Spoljar
- Laboratory for Mineralized Tissues School of Medicine University of Zagreb Zagreb Croatia
| | | | - Drazen Maticic
- Clinics for Surgery, Orthopedics, and Ophthalmology School of Veterinary Medicine University of Zagreb Zagreb Croatia
| | - Mihaela Peric
- Laboratory for Mineralized Tissues School of Medicine University of Zagreb Zagreb Croatia
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery Medical University of Vienna Vienna Austria
| | | | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues School of Medicine University of Zagreb Zagreb Croatia
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Masquelet technique for the treatment of acute osteomyelitis of the PIP joint caused by clenched-fist human bite injury: A case report. Int J Surg Case Rep 2018; 51:282-287. [PMID: 30243260 PMCID: PMC6149196 DOI: 10.1016/j.ijscr.2018.09.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The Masquelet technique is a well-known and efficient procedure for lower limb soft tissue reconstruction after severe osteomyelitis requiring bone excision. However, this technique is rarely used in the hand. PRESENTATION OF CASE The patient was 38-year-old man. We used this technique to reconstruct a proximal interphalangeal (PIP) joint osteochondral defect after osteomyelitis caused by clenched-fist human bite injury. The pathogen was Prevotella intermedia, which is an anaerobic pathogenic bacterium involved in periodontal infections and is a black-pigmented periodontal pathogen. Following completion of the Masquelet method, the bone remodeled at an angle at the PIP joint. DISCUSSION Prevotella intermedia is known as Bacteroides melaninogenicus subsp. intermedius. When the infection site is black-pigmented, this pathogen is highly suspected. The Masquelet technique is rarely used in the hand, and when used, it has been in a straight fashion in the hand. We were able to reconstruct a more anatomical, bent PIP joint, and the fixed angle of the PIP joint at 40° of flexion using Masquelet technique. CONCLUSION The angled joint resulting from this technique created a relatively normal permanently bent PIP joint.
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Liu X, Ding G, Zhou D, Xiang L. Antibiotic-loaded bone cement spacer usage combined with membrane induction in infected gap non-unions: A case series. Pak J Med Sci 2018; 34:1088-1093. [PMID: 30344555 PMCID: PMC6191808 DOI: 10.12669/pjms.345.14569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To explore the clinical effects upon gap nonunion of antibiotic-loaded bone cement spacer combined with membrane induction on infected bone defects. Methods: The data of 16 patients with infected bone defects admitted in General Hospital of Shenyang Military Area Command from January 2009 to January 2011 were analyzed retrospectively. There were 12 males and 4 females aged between 24-63 years age (average 43.1 ± 9.7) who had received antibiotic laiden bone cement spacer treatment. Stage-1, debridement and anti-biotic treatment with intraoperative preparation of customized bone cement spacers (antibiotics and bone cement spacer) with or without internal or external fixation Stage-2, removal of spacer and repair of bone defects using membrane-induced technique and internal fixation at bone defects site. Results: Sixteen patients were followed up for 39-98 months, (67.2 ± 20.4) on average. All patients with infected bone defects were healed. X-ray showed that fractures had healed and the new bone formed at graft site was more radio opaque than that of adjacent bone segments. The healing time was 6 to 10 months, (7.4 ± 1.1) on average. There was no recurrence of infection or deformity. Conclusion: The antibiotic-loaded cement spacer can control the local infection while maintaining the limb length and increasing the stability, reducing the contracture of bone and soft tissue, creating conditions for subsequent repair and reducing the infection rate of bone defects.
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Affiliation(s)
- Xinwei Liu
- Xinwei Liu, Department of Orthopedics, Rescue Center of Severe Wound and Trauma of PLA, General Hospital of Shenyang Military Area Command, Shenyang 110016, P. R. China
| | - Guocheng Ding
- Guocheng Ding, Graduate School, Dalian Medical University, Dalian 116044, P.R. China
| | - Dapeng Zhou
- Dapeng Zhou, Department of Orthopedics, Rescue Center of Severe Wound and Trauma of PLA, General Hospital of Shenyang Military Area Command, Shenyang 110016, P. R. China
| | - Liangbi Xiang
- Liangbi Xiang, Department of Orthopedics, Rescue Center of Severe Wound and Trauma of PLA, General Hospital of Shenyang Military Area Command, Shenyang 110016, P. R. China
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Cano-Luís P, Andrés-Cano P, Ricón-Recarey FJ, Giráldez-Sánchez MA. Treatment of posttraumatic bone defects of the forearm with vascularized fibular grafts. Follow up after fourteen years. Injury 2018; 49 Suppl 2:S27-S35. [PMID: 30219144 DOI: 10.1016/j.injury.2018.07.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Among several techniques proposed for the reconstruction of posttraumatic bone defects of the forearm, that of free vascularised fibular graft (FVFG) is one of the most widely used. PATIENTS AND METHOD We study the long-term outcomes of 14 patients who underwent FVFG between 1994 and 2009, with a minimum follow up of 8 years and a maximum of 23 years (mean: 13.9 years). Demographic, clinical and radiological variables were collected retrospectively. The DASH scale was used for clinical assessment. RESULTS Fourteen patients were operated on by the same surgeon, applying FVFG for the reconstruction of posttraumatic bone defects of the forearm (three septic non-union of the ulna or radius, five radius fractures, two ulna fractures and four fractures of both bones). The maximum length of the defect was 11 cm and the minimum length was 6 cm. In four cases, reconstruction of the two bones was achieved using the double barrel technique, and in another four cases, an osteoseptocutaneous flap was used. Fixation was performed with 3.5 mm reconstruction plates in thirteen cases and with 3.5 mm screws in one case. Consolidation was obtained in 12 cases (85.7%) after an average time of 4.2 months (range: 2-6.5 months). In one case, consolidation of the proximal ulnar fracture site was not achieved, and in another, following the failure of reconstruction attempts, an arthrodesis was performed. At the end of the follow-up period, the patients had an average DASH score of 17.1 points (range 1.8-68.1). CONCLUSIONS FVFG is a valid option for the reconstruction of posttraumatic bone defects of the forearm. Its use via the double barrel method or as an osteocutaneous composite graft enables the simultaneous reconstruction of both forearm bones and associated soft tissue injuries. Long-term follow-up of patients who have undergone this technique confirms its satisfactory functional and radiological results.
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Affiliation(s)
- P Cano-Luís
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - P Andrés-Cano
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - F J Ricón-Recarey
- Orthopaedic Surgery and Traumatology Department, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - M A Giráldez-Sánchez
- Orthopaedic Surgery and Traumatology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Abstract
UNLABELLED A pediatric patient presenting with an open forearm fracture with segmental defect is rare, and the pediatric orthopedic literature to guide treatment is sparse. There are several described methods to treat the defect, including bone grafting and bone transport techniques. In addition, there are reports of fibular regeneration after resection if the periosteum is left intact. We present a case report of complete regeneration of over half of a pediatric radial shaft with an intact periosteum, after traumatic extrusion from an open fracture. A 6-year-old girl presented with a Gustilo Grade-IIIB open fracture with extrusion and loss of 7 cm of her radial shaft. Initially, the arm was stabilized using a monoplanar external fixator. She developed a compartment syndrome and underwent volar forearm fasciotomies. We found her periosteum grossly intact and decided to allow its natural biology to provide healing potential for the radial defect. She was placed into a circular external fixator, leaving her wrist and elbow free, and her ulna was stabilized with a flexible intramedullary nail. Soft tissue coverage was obtained with a split thickness skin graft. The patient's skin graft healed uneventfully and there were radiographic signs of bone regeneration by 2 weeks postoperatively. She maintained most of her elbow and wrist motion while in her external fixator. She developed a small pin site infection that resolved with oral antibiotics. By 10 weeks postoperatively, radiographs showed adequate corticalization and the fixator was removed. By 8 months postoperatively, the patient was released to full activity with nearly full function and range of motion. Our patient sustained a severe and rare injury but had an excellent outcome with minimal complications. This report represents a method of treatment for large bony defects in children if the periosteum is grossly intact, as opposed to more complex procedures. The intact periosteum can regenerate bony defects in the forearm if stabilized appropriately. LEVEL OF EVIDENCE Level 4; case report.
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Gaio N, Martino A, Toth Z, Watson JT, Nicolaou D, McBride-Gagyi S. Masquelet technique: The effect of altering implant material and topography on membrane matrix composition, mechanical and barrier properties in a rat defect model. J Biomech 2018; 72:53-62. [PMID: 29510858 PMCID: PMC5895482 DOI: 10.1016/j.jbiomech.2018.02.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/12/2018] [Accepted: 02/18/2018] [Indexed: 12/26/2022]
Abstract
The Masquelet technique is a surgical procedure to regenerate segmental bone defects. The two-phase treatment relies on the production of a vascularized foreign-body membrane to support bone grafts over three times larger than the traditional maximum. Historically, the procedure has always utilized a bone cement spacer to evoke membrane production. However, membrane formation can easily be effected by implant surface properties such as material and topology. This study sought to determine if the membrane's mechanical or barrier properties are affected by changing the spacer material to titanium or roughening the surface finish. Ten-week-old, male Sprague Dawley rats were given an externally stabilized, 6 mm femur defect which was filled with a pre-made spacer of bone cement (PMMA) or titanium (TI) with a smooth (∼1 μm) or roughened (∼8 μm) finish. After 4 weeks of implantation, the membranes were harvested, and the matrix composition, tensile mechanics, shrinkage, and barrier function was assessed. Roughening the spacers resulted in significantly more compliant membranes. TI spacers created membranes that inhibited solute transport more. There were no differences between groups in collagen or elastin distribution. This suggests that different membrane characteristics can be created by altering the spacer surface properties. Surgeons may unknowingly effecting membrane formation via bone cement preparation techniques.
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Affiliation(s)
- Natalie Gaio
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 1402 S. Grand Blvd, Schwitalla Hall M176, St. Louis, MO 63132, USA
| | - Alice Martino
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 1402 S. Grand Blvd, Schwitalla Hall M176, St. Louis, MO 63132, USA
| | - Zacharie Toth
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 1402 S. Grand Blvd, Schwitalla Hall M176, St. Louis, MO 63132, USA
| | - J Tracy Watson
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 1402 S. Grand Blvd, Schwitalla Hall M176, St. Louis, MO 63132, USA
| | - Daemeon Nicolaou
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 1402 S. Grand Blvd, Schwitalla Hall M176, St. Louis, MO 63132, USA
| | - Sarah McBride-Gagyi
- Department of Orthopaedic Surgery, Saint Louis University School of Medicine, 1402 S. Grand Blvd, Schwitalla Hall M176, St. Louis, MO 63132, USA.
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Lum ZC, Park L, Huff KE, Ibrahim MA. The Masquelet Technique for Thumb Metacarpal Reconstruction Following Trauma: A Case Report. JBJS Case Connect 2018; 8:e19. [PMID: 29595536 DOI: 10.2106/jbjs.cc.17.00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe an unusual case of an isolated close-range shotgun injury to the thumb with substantial osseous loss and intact vascularity, followed by treatment with the Masquelet technique and iliac crest tricortical bone autograft reconstruction. CONCLUSION Gunshot injuries to the thumb with concomitant soft-tissue and osseous loss are devastating. Reconstruction depends on the level of the injury, the severity of the soft-tissue and osseous damage, and the viability of the digit, as well as patient factors, including occupation, physical demands, and expectations.
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Affiliation(s)
- Zachary C Lum
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, California
| | - Lily Park
- Department of Internal Medicine, California Pacific Medical Center, Davies Campus, San Francisco, California
| | - Kathryn E Huff
- Department of Orthopaedic Surgery, Doctors Medical Center, Modesto, California
| | - Mohamed A Ibrahim
- Department of Orthopaedic Surgery, Doctors Medical Center, Modesto, California
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Abstract
Mangled hand injuries are defined as those with significant damage to multiple structures, which may be limb threatening. Historically these injuries resulted in amputation or death, but modern surgical and perioperative advances allow for complex reconstruction and the possibility of a sensate and functional limb. Evaluation begins with surveying for life-threatening injuries followed by a systematic approach to identify injured structures; management begins with preserving all parts, minimizing warm ischemia time, performing débridement, and planning an operative approach to optimize the chance of a functional limb. With careful surgical planning and a well-executed reconstruction, most limbs can be salvaged.
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Affiliation(s)
- Rick Tosti
- Department of Orthopedic Surgery, The Philadelphia Hand Center, Sidney Kimmel Medical College, Thomas Jefferson University, 834 Chestnut Street Suite G114, Philadelphia, PA 19107, USA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Harvard Medical School, Massachusetts General Hospital, Wang Building, 55 Fruit Street, Boston, MA 02114, USA.
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44
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Luo TD, Nunez FA, Lomer AA, Nunez FA. Management of recalcitrant osteomyelitis and segmental bone loss of the forearm with the Masquelet technique. J Hand Surg Eur Vol 2017; 42:640-642. [PMID: 27234664 DOI: 10.1177/1753193416650171] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- T D Luo
- 1 Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - F A Nunez
- 1 Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - A A Lomer
- 2 Centro Medico Guerra Mendez, Valencia, Venezuela
| | - F A Nunez
- 2 Centro Medico Guerra Mendez, Valencia, Venezuela
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Sasaki G, Watanabe Y, Miyamoto W, Yasui Y, Morimoto S, Kawano H. Induced membrane technique using beta-tricalcium phosphate for reconstruction of femoral and tibial segmental bone loss due to infection: technical tips and preliminary clinical results. INTERNATIONAL ORTHOPAEDICS 2017; 42:17-24. [PMID: 28536801 DOI: 10.1007/s00264-017-3503-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/07/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE This study aimed to provide preliminary evidence regarding effectiveness of grafting beta-tricalcium phosphate (β-TCP) combined with a cancellous autograft for treating nonunion of long bones in the lower extremity due to infection by evaluating clinical and radiological outcomes. METHODS We retrospectively reviewed the clinical and radiological results in seven patients (six men, one woman; median age 39 years) treated by the induced membrane technique for nonunion of the femur or tibia due to infection. In the second stage of the procedure, the bony defect was filled with a combination of autologous cancellous bone and β-TCP, which were mixed in approximately the same proportions. The time interval between the second stage of the procedure and bone healing was investigated. Radiographic characteristics including maximum bone gap and radiographic apparent bone gap were evaluated. RESULTS The median follow-up period was 14 months. Bone healing was achieved in a median of six months after the second procedure. The median maximum bone gap and radiographic apparent bone gap were 55 mm and 34 mm, respectively. DISCUSSION Use of β-TCP, which has osteoconductive ability, with an autograft provided good clinical and radiological outcomes. The findings of this preliminary study suggest the potential of β-TCP as a useful bone substitute for autografts in the induced membrane technique. CONCLUSIONS Our findings suggest that β-TCP may be an effective extender when using the induced membrane technique.
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Affiliation(s)
- Gen Sasaki
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan.
| | - Yoshinobu Watanabe
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Wataru Miyamoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Youichi Yasui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Shota Morimoto
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
| | - Hirotaka Kawano
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan
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Dilogo IH, Primaputra MRA, Pawitan JA, Liem IK. Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report. Int J Surg Case Rep 2017; 34:11-16. [PMID: 28324799 PMCID: PMC5358950 DOI: 10.1016/j.ijscr.2017.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 01/15/2023] Open
Abstract
A case of infected non-union fracture with critical-sized bone defect. Modified Masquelet technique was used to overcome the defect. The addition of allogenic UC-MSCs, BMP-2 and hydroxyapatite encourages healing. This technique may serve as an effective way to overcome large defects.
Introduction Non-union due to large bone loss often causes significant long-term morbidity. We incorporate the use of allogeneic umbilical cord-derived mesenchymal stem cells (UC-MSCs) as part of the diamond concept of regenerative medicine in a case of infected non-union fracture. Presentation of case We reported a 54-year-old female patient presenting with pain on the right thigh. She was previously diagnosed with a closed fracture of the right femoral shaft and underwent four surgeries before finally being referred to Dr. Cipto Mangunkusumo General Hospital with infected non-union of the right femoral shaft. The patient was treated with a combination of UC-MSCs, bone morphogenetic protein-2 (BMP-2), Hydroxyapatite (HA), and mechanical stabilization using Masquelet Technique. The combination of allogeneic MSCs, BMP2, HA, and Masquelet Technique was successful in creating new bone with no apparent side effects. Discussion Bone loss might be caused by external factors (true defects), or structural loss of the existing bone. The combination of allogeneic UC-MSCs, BMP-2, HA and an induced membrane technique pioneered by Masquelet allowed for faster regeneration process and more optimal bone healing. This paper aims to assess and compare the result of such procedures with the previous four surgeries done to the patient, which did not yield satisfactory results. Conclusion The application of allogeneic UC-MSC, BMP-2, HA and Masquelet technique as proposed in the diamond concept is a viable method in treating critical-sized bone defect and provides an effective way to overcome non-union caused by large defect.
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Affiliation(s)
- Ismail Hadisoebroto Dilogo
- Consultant of Orthopaedic Trauma and Reconstruction, Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell Medical Technology, Integrated Service Unit, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell and Tissue Engineering Research Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
| | - Muhammad Rizqi Adhi Primaputra
- Resident of Orthopaedic Surgery, Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Jeanne Adiwinata Pawitan
- Department of Histology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell Medical Technology, Integrated Service Unit, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell and Tissue Engineering Research Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Isabella Kurnia Liem
- Stem Cell Medical Technology, Integrated Service Unit, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Department of Anatomy, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Stem Cell and Tissue Engineering Research Center, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Osteomyelitis of the ulna secondary to krokodil injection requiring extensive bony resection. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Davis JA, Choo A, O'Connor DP, Brinker MR. Treatment of Infected Forearm Nonunions With Large Complete Segmental Defects Using Bulk Allograft and Intramedullary Fixation. J Hand Surg Am 2016; 41:881-7. [PMID: 27406322 DOI: 10.1016/j.jhsa.2016.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/26/2016] [Accepted: 05/30/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to report the results of a series of infected forearm nonunions treated from 1998 to 2012 using a staged reconstruction technique. METHODS At a median of 42 months follow-up, 7 patients who had an average segmental defect of 4.9 cm (range, 2.3-10.4 cm) were available for clinical and radiographic evaluation. Treatment consisted of serial debridement, implantation of an antibiotic cement spacer, and staged reconstruction using a bulk radius or ulna allograft with intramedullary fixation. RESULTS All 7 patients ultimately achieved solid bone union, although 4 patients (57%) required additional surgery, consisting of autologous bone grafting and plating, to achieve healing at 1 of the allograft-host junction sites. No patient had recurrence of infection, and all reported substantial improvement with increased function and decreased pain. CONCLUSIONS Our approach ultimately resulted in a 100% union rate without recurrence of infection, although many patients may require additional surgery to attain healing at both allograft-junction sites. Using bulk allograft provides the ability to span a large defect while reconstituting the forearm anatomy. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Jason A Davis
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Andrew Choo
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX
| | - Daniel P O'Connor
- Department of Health and Human Performance, University of Houston, Houston, TX.
| | - Mark R Brinker
- Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, Houston, TX; Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX
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Rhee PC, Shin AY. Management of Complex Distal Radius Fractures: Review of Treatment Principles and Select Surgical Techniques. J Hand Surg Asian Pac Vol 2016; 21:140-54. [PMID: 27454627 DOI: 10.1142/s2424835516400063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Most distal radius fractures are the result of low-energy mechanisms that can be successfully treated either non-operatively or with a variety of operative techniques if indicated. Complex distal radius fractures occur most commonly in high-energy injuries with extensive comminution or bone loss and associated soft tissue or vascular injuries. These high-energy fractures can present many challenges in reconstructing the distal radius. Effective restoration of the bony architecture requires a thorough knowledge of distal radius anatomy, understanding of the goals of treatment, versatility in surgical approaches, and familiarity with multiple fixation options.
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Affiliation(s)
- Peter Charles Rhee
- Division of Hand and Microvascular Surgery, Department of Orthopaedic Surgery, San Antonio Military Medical Center, Fort Sam Houston, TX, United States
| | - Alexander Y. Shin
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States
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Tarchala M, Harvey EJ, Barralet J. Biomaterial-Stabilized Soft Tissue Healing for Healing of Critical-Sized Bone Defects: the Masquelet Technique. Adv Healthc Mater 2016; 5:630-40. [PMID: 26855349 DOI: 10.1002/adhm.201500793] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/10/2015] [Indexed: 12/23/2022]
Abstract
Critical-sized bone defects present a significant burden to the medical community due to their challenging treatment. However, a successful limb-salvaging technique, the Masquelet Technique (MT), has significantly improved the prognosis of many segmental bone defects in helping to restore form and function. Although the Masquelet Technique has proven to be clinically effective, the physiology of the healing it induces is not well understood. Multiple modifiable factors have been implicated by various surgical and research teams, but no single factor has been proven to be critical to the success of the Masquelet Technique. In this review the most recent clinical and experimental evidence that supports and helps to decipher the traditional Masquelet, as well as the modifiable factors and their effect on the success of the technique are discussed. In addition, future developments for the integration of the traditional Masquelet Technique with the use of alternative biomaterials to increase the effectiveness and expand the clinical applicability of the Masquelet Technique are reviewed.
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Affiliation(s)
- Magdalena Tarchala
- Division of Orthopaedic Surgery; McGill University Health Centre; Montreal H3g 1A4 Quebec Canada
| | - Edward J. Harvey
- Division of Orthopaedic Surgery; McGill University Health Centre; Montreal H3g 1A4 Quebec Canada
| | - Jake Barralet
- Faculty of Dentistry; McGill University; Montreal H3A 0G4 Quebec Canada
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