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Baumgartner H, Schüll D, Kolbenschlag J, Mederake M. [Reconstruction of posttraumatic deformities and defects]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:738-745. [PMID: 37606652 DOI: 10.1007/s00132-023-04422-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/23/2023]
Abstract
The reconstruction of posttraumatic defects of bone and soft tissue, as well as residual deformities of the bone is often a lengthy and complicated procedure. Multiple surgical interventions are necessary to reconstruct the affected extremity and restore its functionality. To achieve an optimal result it often takes months or years and requires great patience and compliance of the patient. This treatment should be carried out in centers with the appropriate instrumental and human resources. Since the pathologies are often complex with bony deformities or loss of bone, as well as infections and soft tissue defects, the treatment should be carried out by very experienced surgeons to successfully manage these complex reconstructions. This often requires interdisciplinary cooperation, especially with experienced plastic surgeons. A soft tissue reconstruction for better blood circulation in the exposed bony structures, as well as the bony defects themselves, can be reconstructed at the same time.
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Affiliation(s)
- Heiko Baumgartner
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - Daniel Schüll
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland.
- BG Klinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Deutschland.
| | - Jonas Kolbenschlag
- BG Unfallklinik Tübingen, Klinik für Hand‑, Plastische, Rekonstruktive und Verbrennungschirurgie, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - Moritz Mederake
- BG Unfallklinik Tübingen, Klinik für Unfall- und Wiederherstellungschirurgie, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
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Klein C, Gindraux F, Masquelet AC, Mentaverri R, Gouron R. Questions about Using the Induced Membrane Technique to Manage Cases of Congenital Tibial Pseudarthrosis. Cells 2023; 12:1918. [PMID: 37508581 PMCID: PMC10378057 DOI: 10.3390/cells12141918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
The induced membrane technique is an innovative approach for repairing critical bone defects and has been applied recently in patients with congenital pseudarthrosis of the tibia (CPT). CPT is frequently associated with neurofibromatosis type 1 (NF1). Here, we briefly describe the clinical results of the induced membrane technique in NF1-deficient patients with CPT and in an animal model of CPT. Furthermore, we discuss the hypotheses used to explain inconsistent outcomes for the induced membrane technique in CPT-especially when associated with NF1.
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Affiliation(s)
- Céline Klein
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital, Jules Verne University of Picardie, F-80054 Amiens, France
- MP3CV-EA7517, CURS-Amiens University Medical Center, Jules Verne University of Picardie, F-80025 Amiens, France
- Service D'orthopédie et Traumatologie Pédiatrique, CHU Amiens-Picardie, F-80054 Amiens CEDEX 1, France
| | - Florelle Gindraux
- CHU Besançon, Service de Chirurgie Orthopédique, Traumatologique et Plastique, F-25000 Besançon, France
- Laboratoire de Nanomédecine, Imagerie, Université de Franche-Comté, Thérapeutique EA 4662 (LNIT), F-25000 Besançon, France
| | | | - Romuald Mentaverri
- MP3CV-EA7517, CURS-Amiens University Medical Center, Jules Verne University of Picardie, F-80025 Amiens, France
- CHU Besançon, Service de Chirurgie Orthopédique, Traumatologique et Plastique, F-25000 Besançon, France
- Laboratoire de Nanomédecine, Imagerie, Université de Franche-Comté, Thérapeutique EA 4662 (LNIT), F-25000 Besançon, France
- Hôpital Saint Antoine, Sorbonne Université, F-75006 Paris, France
- Department of Biochemistry and Endocrine Biology, Amiens University Medical Center, Jules Verne University of Picardie, F-80025 Amiens, France
| | - Richard Gouron
- Department of Paediatric Orthopaedic Surgery, Amiens University Hospital, Jules Verne University of Picardie, F-80054 Amiens, France
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Ahmed H, Shakshak M, Trompeter A. A review of the Masquelet technique in the treatment of lower limb critical-size bone defects. Ann R Coll Surg Engl 2023. [PMID: 37367227 DOI: 10.1308/rcsann.2023.0022] [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: 06/28/2023] Open
Abstract
The need for bone tissue to heal effectively is paramount given its role in the mechanical support of tissues. Bone has a very good natural healing potential in comparison with most other tissue types, largely regenerating to its pre-injury state in the vast majority of cases. Certain factors such as high energy trauma, tumour resection, revision surgery, developmental deformities and infection can lead to the formation of bone defects, where the intrinsic healing potential of bone is diminished owing to bone loss. Various approaches to resolving bone defects exist in current practice, each with their respective benefits and drawbacks. These include bone grafting, free tissue transfer, Ilizarov bone transport and the Masquelet induced membrane technique. This review focuses on evaluating the Masquelet technique, discussing its method and underlying mechanisms, the effectiveness of certain modifications, and its potential future directions.
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Affiliation(s)
- H Ahmed
- St George's, University of London, UK
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Tazi Charki M, Oudrhiri Z, Abdellaoui H, Atarraf K, Afifi MA. Reconstruction of the clavicle by the induced membrane technique after resection of an aneurysmal bone cyst in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mittal R, Jain S. Modified Masquelet technique in children. Chin J Traumatol 2022; 25:389-391. [PMID: 34580002 PMCID: PMC9751581 DOI: 10.1016/j.cjtee.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 07/21/2021] [Accepted: 08/20/2021] [Indexed: 02/04/2023] Open
Abstract
Masquelet technique is one of the modalities for the treatment of long bone defect. Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and open growth plate. We reported a case of 13-year-old male who presented with gap non-union of middle third of tibia. We applied a modified Masquelet technique by using only the cortical fibular graft instead of cancellous bone to fill the space surrounded by induced membrane. Fibula was used as a nonvascularized strut graft and matched stick graft to achieve complete union. We concluded that nonvascularized fibula grafting is an easy and effective option to fill the bone defect in children in the second stage of Masquelet technique.
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Rohilla R, Sharma PK, Wadhwani J, Das J, Singh R, Beniwal D. Prospective randomized comparison of bone transport versus Masquelet technique in infected gap nonunion of tibia. Arch Orthop Trauma Surg 2022; 142:1923-1932. [PMID: 33983526 DOI: 10.1007/s00402-021-03935-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/02/2021] [Indexed: 12/12/2022]
Abstract
AIM The present prospective randomized study compared the bone transport technique (BT) and Masquelet technique (MT) in the treatment of infected gap non-union of the tibia. PATIENTS AND METHODS Total 25 patients with infected gap non-union of the tibia with bone gap upto 6 cm were randomised into BT group (group I, 13 patients) and MT (group II, 12 patients). The mean age was 31.77 years in group I and 39.67 years in group II. The mean intra-operative bone gap was 3.92 cm in group I and 3.79 cm in group II. Monolateral fixator was applied in nine patients each in both groups, while four and three fractures were stabilized with ring fixators in group I and II, respectively. Mean follow-up was 31.62 months and 30.42 months in group I and II, respectively. Bone and functional results were compared using the association for the study and application of the method of Ilizarov (ASAMI) criteria. RESULTS The average fixator period was 9.42 and 16.33 months in group I and II, respectively (p < 0.001). Union was achieved in 12 (92%) patients and 6 (50%) patients in group I and II, respectively. The functional results were excellent (eight and two), good (four and six), fair (zero and three) and poor (one and one) in group I and II respectively, (p 0.23). The Bone results were excellent, good and poor in nine, three and one patients in group I, and three, three and six patients in group II respectively, (p 0.109). CONCLUSIONS The functional and bone results were comparable but more reliable in bone transport than the Masquelet technique. The fixator duration and incidence of non-union were higher in MT group. Ilizarov bone transport technique should be preferred in infected non-union of the tibia with bone loss upto 6 cm.
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Affiliation(s)
- Rajesh Rohilla
- Department of Sports Medicine, PGIMS, Pt. B. D. Sharma, Health University, Rohtak, 124001, Haryana, India
| | - Pankaj Kumar Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur Romana, Mandi Dabwali Road, Bathinda, 151001, Punjab, India.
| | - Jitendra Wadhwani
- Department of Orthopaedics, PGIMS, Pt. B. D. Sharma, Health University, Rohtak, 124001, Haryana, India
| | | | - Roop Singh
- Department of Orthopaedics, PGIMS, Pt. B. D. Sharma, Health University, Rohtak, 124001, Haryana, India
| | - Deepsikha Beniwal
- Department of Sports Medicine, PGIMS, Pt. B. D. Sharma, Health University, Rohtak, 124001, Haryana, India
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Free Vascularized Fibula Salvage of Failed CPH in Pediatric Sarcoma Patients. Sarcoma 2022; 2022:6240293. [PMID: 35586727 PMCID: PMC9110248 DOI: 10.1155/2022/6240293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/24/2022] Open
Abstract
Background Due to extended life expectancy and recent improvements in surgical techniques, limb salvage has replaced amputation as the gold standard and is now performed in 90–95% of upper extremity malignancies. However, many of these salvage procedures are associated with significant postsurgical complications. In particular, the clavicula pro humero (CPH) procedure is associated with high rates of nonunion. We present our experience with upper extremity salvage using the free vascularized fibular flap (VFF) after failure or nonunion of the original CPH procedure in the pediatric population. Methods Five patients under the age of 18 diagnosed with upper extremity sarcoma who underwent tumor resection with immediate CPH reconstruction complicated with nonunion, and subsequent revision with free VFF were included. Data on patient demographics, oncologic characteristics, surgical procedures, intraoperative details, postoperative complications, and time to graft union were recorded. Results Five patients (average age = 8.4 years; range = 5–10 years at surgery date) underwent secondary limb salvage procedure with free VFF reconstruction following failed CPH reconstruction for proximal humeral osteosarcoma (n = 4) or Ewing sarcoma (n = 1). The mean follow-up was 3.7 years. Complications occurred in five patients (100%), with three patients requiring reoperation (60%). Four patients achieved graft union (average union time = 3.7 months) and successful limb reconstruction. Four patients were alive with no local recurrence of the disease. One patient did not achieve union and was lost to follow-up. Conclusion Primary bone tumors in the pediatric population require wide surgical resection, and reconstruction often has high complication rates that can warrant further procedures. A free VFF is a viable option for upper extremity salvage after previously failed reconstructions because it provides vascularized tissue to a scarred tissue bed and allows for the replacement or augmentation of large bony defects.
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Cyphert EL, Kanagasegar N, Zhang N, Learn GD, von Recum HA. PMMA Bone Cement Composite Functions as an Adjuvant Chemotherapeutic Platform for Localized and Multi-Window Release During Bone Reconstruction. Macromol Biosci 2022; 22:e2100415. [PMID: 35113499 DOI: 10.1002/mabi.202100415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/06/2022] [Indexed: 11/10/2022]
Abstract
Primary bone tumor resections often result in critical size defects, which then necessitate challenging clinical management approaches to reconstruct. One such intervention is the Masquelet technique, in which poly(methyl methacrylate) (PMMA) bone cement is placed as a spacer temporarily while adjuvant chemotherapeutics are administered systemically. The spacer is later removed and replaced with bone autograft. Local recurrence remains an important and devastating problem, therefore, a system capable of locally delivering chemotherapeutics would present unique advantages. In this work, a refillable chemotherapeutic (doxorubicin, DOX) delivery platform comprised of PMMA bone cement and insoluble γ-cyclodextrin (γ-CD) polymeric microparticles is developed and explored towards application as a temporary adjuvant chemotherapeutic spacer. The system is characterized for porosity, mechanical strength, DOX filling and refilling capacity, elution kinetics, and cytotoxicity. Since residual chemotherapeutics could adversely impact bone healing, it is important that virtually all DOX be released from material. Composites containing 15wt% γ-CD microparticles demonstrate 100% DOX release within 100 days, whereas only 6% DOX is liberated from PMMA with free DOX over same period. Refillable properties of PMMA composite system may find utility for customizing dosing regimens. Findings suggest that PMMA composites could have potential as chemotherapeutic delivery platforms to assist in bone reconstruction. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Erika L Cyphert
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Nithya Kanagasegar
- School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Ningjing Zhang
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Greg D Learn
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Horst A von Recum
- Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
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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: 4] [Impact Index Per Article: 1.3] [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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Hopyan S. Reconstruction for bone tumours of the shoulder and humerus in children and adolescents. J Child Orthop 2021; 15:358-365. [PMID: 34476025 PMCID: PMC8381401 DOI: 10.1302/1863-2548.15.210131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 06/28/2021] [Indexed: 02/03/2023] Open
Abstract
Reconstructions for paediatric bone tumours of the shoulder girdle and humerus are intended to optimize placement of the hand in space. Given the longevity of paediatric survivors of sarcoma, durability is an important planning consideration. Here, I review a subset of approaches based on anatomical site with an emphasis on function and longevity. Often, biological reconstructions that combine living bone with tendon repairs and transfers best address those goals.
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Affiliation(s)
- Sevan Hopyan
- Division of Orthopaedics and Program in Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto,Division of Orthopaedics, Department of Surgery and Department of Molecular Genetics, University of Toronto,Correspondence should be sent to Sevan Hopyan, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8. E-mail:
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Rougereau G, Marty-Diloy T, Pietton R, Koneazny C, Fitoussi F, Vialle R, Mary P, Langlais T. Forearm reconstruction by induced-membrane technique after sarcoma resection in children: technique and functional outcome in three cases. HAND SURGERY & REHABILITATION 2021; 40:799-803. [PMID: 34171528 DOI: 10.1016/j.hansur.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Forearm sarcoma is rare in children. Here, we report three cases. One child presented undifferentiated soft-tissue sarcoma involving the ulna, another had Ewing's sarcoma of the ulna, and the third had Ewing's sarcoma of the proximal radius. In the first case, there were episodes of iterative aseptic nonunion, treated surgically. At last follow-up (respectively 11, 9 and 8 years postoperatively), the mean Musculoskeletal Tumor Society (MSTS) score was 80%, 90% and 77% respectively, and all cases were in remission. The induced membrane technique to reconstruct bone defect after sarcoma resection in children is a possible limb-salvage strategy.
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Affiliation(s)
- G Rougereau
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Marty-Diloy
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Pietton
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - C Koneazny
- The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - F Fitoussi
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - R Vialle
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; The MAMUTH Hospital University, Department for Innovative Therapies in Musculoskeletal Disease, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - P Mary
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - T Langlais
- Department of Pediatric Orthopedics, Armand-Trousseau Hospital, Sorbonne University, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Department of Pediatric Orthopedics, Purpan Hospital, 330 Avenue de Grande Bretagne, 31300 Toulouse, France.
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El Beaino M, Wang WL, Alaraj SF, Gugala Z, Lin PP. Osteofibrous dysplasia and adamantinoma: A summary of diagnostic challenges and surgical techniques. Surg Oncol 2021; 38:101626. [PMID: 34280695 DOI: 10.1016/j.suronc.2021.101626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
Osteofibrous dysplasia is an indolent benign fibro-osseous tumor, while adamantinoma is a locally aggressive biphasic malignancy with epithelial and fibro-osseous components. Predominantly arising in the tibial diaphysis of children and young adults, both tumors are resistant to chemotherapy and radiation. Wide surgical resection is regarded as the mainstay of therapy for adamantinoma, and limb-salvage reconstructive procedures can achieve good functional outcomes, albeit with non-negligible rates of complications. This review discusses emerging advances in the pathogenesis, histogenesis, and diagnosis of these entities and presents advantages and limitations of the most common surgical techniques used for their management.
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Affiliation(s)
- Marc El Beaino
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA; School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Wei-Lien Wang
- Department of Pathology and Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sami F Alaraj
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Zbigniew Gugala
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX, USA
| | - Patrick P Lin
- Department of Orthopaedic Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Gwon Y, Park S, Kim W, Han T, Kim H, Kim J. Radially patterned transplantable biodegradable scaffolds as topographically defined contact guidance platforms for accelerating bone regeneration. J Biol Eng 2021; 15:12. [PMID: 33752709 PMCID: PMC7986475 DOI: 10.1186/s13036-021-00263-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The healing of large critical-sized bone defects remains a clinical challenge in modern orthopedic medicine. The current gold standard for treating critical-sized bone defects is autologous bone graft; however, it has critical limitations. Bone tissue engineering has been proposed as a viable alternative, not only for replacing the current standard treatment, but also for producing complete regeneration of bone tissue without complex surgical treatments or tissue transplantation. In this study, we proposed a transplantable radially patterned scaffold for bone regeneration that was defined by capillary force lithography technology using biodegradable polycaprolactone polymer. RESULTS The radially patterned transplantable biodegradable scaffolds had a radial structure aligned in a central direction. The radially aligned pattern significantly promoted the recruitment of host cells and migration of osteoblasts into the defect site. Furthermore, the transplantable scaffolds promoted regeneration of critical-sized bone defects by inducing cell migration and differentiation. CONCLUSIONS Our findings demonstrated that topographically defined radially patterned transplantable biodegradable scaffolds may have great potential for clinical application of bone tissue regeneration.
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Affiliation(s)
- Yonghyun Gwon
- Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju, 61186, Republic of Korea
- Interdisciplinary Program in IT-Bio Convergence System, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Sunho Park
- Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju, 61186, Republic of Korea
- Interdisciplinary Program in IT-Bio Convergence System, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Woochan Kim
- Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Taeseong Han
- Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Hyoseong Kim
- Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Jangho Kim
- Department of Rural and Biosystems Engineering, Chonnam National University, Gwangju, 61186, Republic of Korea.
- Interdisciplinary Program in IT-Bio Convergence System, Chonnam National University, Gwangju, 61186, Republic of Korea.
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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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Adam D, Hamel A, Perrot P, Duteille F. Long-term behavior of the vascularized fibular free flap for reconstruction of bony defects in children. ANN CHIR PLAST ESTH 2020; 65:219-227. [DOI: 10.1016/j.anplas.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
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Jia C, Wang X, Yu S, Wu H, Shen J, Huang Q, Xie Z. An antibiotic cement-coated locking plate as a temporary fixation for treatment of infected bone defects: a new method of stabilization. J Orthop Surg Res 2020; 15:44. [PMID: 32046768 PMCID: PMC7014650 DOI: 10.1186/s13018-020-1574-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background The induced membrane technique has achieved good clinical results in the treatment of infected bone defects, and external fixation is the main method, but it causes inconvenience and complications in patients. In this study, our objective was to investigate the outcomes of using an antibiotic cement-coated locking plate as a temporary internal fixation in the first stage of the surgical induced membrane technique for treating extremities with infected bone defects. Methods We retrospectively analysed patients with lower extremity infected bone defects in our department between January 2013 and December 2017. All patients were treated with the induced membrane technique. In the first stage, the defects were stabilized with an antibiotic cement-coated locking plate as a temporary fixation after debridement, and polymethyl methacrylate cement was implanted to induce the formation of a membrane. In the second stage, bone grafting rebuilt the bone defects after infection control, and the temporary fixation was changed to a stronger fixation. Results A total of 183 patients were enrolled, with an average follow-up duration of 32.0 (12–66) months. There were 154 males and 29 females with an average age of 42.8 (10–68) years. The infection sites included 81 femurs, 100 tibias and 2 fibulas. After the first stage of treatment (infection control), 16 (8.7%) patients had recurrence of infection. In terms of the incidence of complications, 4 patients had poor wound healing, 2 patients had fixation failure and 1 patient had femoral fracture due to a fall. After the second stage of treatment (bone reconstruction), there were 24 (13.1%) recurrences of infection, with a mean time of 9.9 months (range 0.5 to 36). Among them, 18 patients underwent bone grafting after re-debridement, 6 received permanent placement of antibiotic bone cement after debridement and 2 patients refused further treatment and chose amputation. Bone healing was achieved in 175 (95.9%) patients at the last follow-up, and the average time to bone union was 5.4 (4–12) months. Conclusions Antibiotic cement-coated locking plates have good clinical effects in the control of bone infection, but attention must be paid to the possible difficulty of skin coverage when applied in calves.
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Affiliation(s)
- Chao Jia
- Department of Orthopedics, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China
| | - Xiaohua Wang
- Department of Orthopedics, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China
| | - Shengpeng Yu
- Department of Orthopedics, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China
| | - Hongri Wu
- Department of Orthopedics, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China
| | - Jie Shen
- Department of Orthopedics, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China
| | - Qiang Huang
- Department of Orthopaedics, Traditional Chinese Medicine Hospital, Shaping Ba District, Chongqing, 400038, People's Republic of China
| | - Zhao Xie
- Department of Orthopedics, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, People's Republic of China.
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Gannamani S, Kidiyoor B, Kilaru P, Joseph VM, Rao Rachakonda K, Nugur A. Successful Reimplantation of an 18-cm-Long Extruded Femur in an Open Fracture: A Case Report. JBJS Case Connect 2019; 9:e0371. [PMID: 31609749 DOI: 10.2106/jbjs.cc.18.00371] [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
CASE A 45-year-old man presented with a Gustillo Anderson type III A open segmental right femur shaft fracture with intercondylar extension and with an 18-cm extruded segment of bone. After sterilization, the segment of bone was reimplanted. The fracture healed, and the patient is ambulant without support with no signs of any infection after 2 years of follow-up. CONCLUSIONS In cases of open fracture with an extruded bone segment available, depending on the timing of presentation, soft tissue status, and level of contamination of the bone segment, reimplantation of the extruded bone can yield a satisfactory result.
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Affiliation(s)
| | - Brijesh Kidiyoor
- Department of Orthopaedics, Sunshine Hospitals, Secunderabad, India
| | - Praful Kilaru
- Department of Orthopaedics, Sunshine Hospitals, Secunderabad, India
| | | | | | - Ashwani Nugur
- Department of Orthopaedics, Sunshine Hospitals, Secunderabad, India
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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: 119] [Impact Index Per Article: 23.8] [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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19
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Haddad B, Zribi S, Haraux E, Deroussen F, Gouron R, Klein C. Induced membrane technique for clavicle reconstruction in paediatric patients: Report of four cases. Orthop Traumatol Surg Res 2019; 105:733-737. [PMID: 31088774 DOI: 10.1016/j.otsr.2019.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/11/2019] [Accepted: 03/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clavicular reconstruction in paediatric patients is a rarely performed procedure that often raises complex technical challenges and produces unreliable outcomes. The induced membrane technique is an innovative two-stage procedure involving cement spacer placement into the defect to induce the development of a membrane, followed by the implantation of a cortical-cancellous bone graft. The primary objective of this study was to assess the medium- and long-term clinical and radiographic outcomes of clavicular reconstruction using the induced membrane technique in children and to highlight the advantages and drawbacks of this technique. The secondary objectives were to evaluate the fixation and the outcomes according to age and to the underlying diagnosis. HYPOTHESIS Clavicular reconstruction using the induced membrane technique produces good outcomes in paediatric patients. PATIENTS AND METHODS The induced membrane technique was used for clavicular reconstruction in 4 children with a mean age of 9.7 years (range, 7.4-12.3 years). The diagnosis was congenital pseudarthrosis of the clavicle in 3 patients and aneurysmal bone cyst in 1 patient. Shoulder pain and mobility were assessed at last follow-up. Radiological bone healing was evaluated using the total radiographic union score (RUS, range, 0-10). Complications and number of procedures per patient were recorded. RESULTS Mean follow-up was 3.9 years (range, 1-8.4 years). None of the patients had pain or motion range limitation. After 6 months, the clavicle was healed with a RUS of 10 in all patients. The mean number of surgical procedures per patient was 3.75 (range, 3-5). Two patients required revision surgery for distal pin migration and another for a subcutaneous abscess under the pin. DISCUSSION When used for clavicular reconstruction, the induced membrane technique is effective and associated with a low complication rate. The induced membrane technique therefore deserves to be viewed as an alternative to other methods. LEVEL OF EVIDENCE IV, retrospective observational study.
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Affiliation(s)
- Benjamin Haddad
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU d'Amiens, 80054 Amiens cedex 1, France
| | - Samuel Zribi
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU d'Amiens, 80054 Amiens cedex 1, France
| | - Elodie Haraux
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU d'Amiens, 80054 Amiens cedex 1, France
| | - François Deroussen
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU d'Amiens, 80054 Amiens cedex 1, France
| | - Richard Gouron
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU d'Amiens, 80054 Amiens cedex 1, France
| | - Céline Klein
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU d'Amiens, 80054 Amiens cedex 1, France.
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20
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Wang J, Yin Q, Gu S, Wu Y, Rui Y. Induced membrane technique in the treatment of infectious bone defect: A clinical analysis. Orthop Traumatol Surg Res 2019; 105:535-539. [PMID: 30858038 DOI: 10.1016/j.otsr.2019.01.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 11/29/2018] [Accepted: 01/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND At present, it is still a challenge for repairing a wide range of bone defect caused by various reasons. We aimed to investigate the effect of induced membrane technique in the treatment of infectious bone defect. PATIENTS AND METHODS The clinical data of twenty-one patients with infectious bone defect that received induced membrane technique treatment from January 2008 to August 2017 were collected for this study. The complications were recorded, and the bone defect healing and the recovery of joint function were evaluated by Paley method. The adjacent joint activities were also evaluated. RESULTS One month after the first stage of surgery, one case had wound dehiscence, and others healed well without infection. Six cases had induced membrane injury during the second stage of surgery, and 4 of them received induced membrane wrapping reconstruction. At the last follow-up, bone defect healing was excellent, the joint function was restored (the rate of excellent and good was 90.5%). The joint range of motion recovered well and the rate of excellent and good was 81.0%. CONCLUSION Induction membrane technique in the treatment of infectious bone defect has advantages of simple operation, rapid healing of bone defects, and low recurrence rate of infection.
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Affiliation(s)
- Jianbing Wang
- Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi 214062, Jiangsu, China
| | - Qudong Yin
- Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi 214062, Jiangsu, China
| | - Sanjun Gu
- Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi 214062, Jiangsu, China
| | - Yongwei Wu
- Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi 214062, Jiangsu, China
| | - Yongjun Rui
- Department of Orthopaedics, Wuxi the Ninth People's Hospital Affiliated to Soochow University, No. 999 Liangxi Road, Wuxi 214062, Jiangsu, China.
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21
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Moteki T, Yanagawa T, Saito K. Autograft treated with liquid nitrogen combined with the modified Masquelet technique for bone defect after resection of malignant bone tumors: Two case reports. J Orthop Sci 2019; 24:573-577. [PMID: 28153375 DOI: 10.1016/j.jos.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 11/14/2016] [Accepted: 01/10/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Tomohiko Moteki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan
| | - Takashi Yanagawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Kenichi Saito
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa, Maebashi, Gunma, 371-8511, Japan
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22
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Siboni R, Joseph E, Blasco L, Barbe C, Bajolet O, Diallo S, Ohl X. Management of septic non-union of the tibia by the induced membrane technique. What factors could improve results? Orthop Traumatol Surg Res 2018; 104:911-915. [PMID: 29886150 DOI: 10.1016/j.otsr.2018.04.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 02/04/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Management of septic non-union of the tibia requires debridement and excision of all infected bone and soft tissues. Various surgical techniques have been described to fill the bone defect. The "Induced Membrane" technique, described by A. C. Masquelet in 1986, is a two-step procedure using a PMMA cement spacer around which an induced membrane develops, to be used in the second step as a bone graft holder for the bone graft. The purpose of this study was to assess our clinical and radiological results with this technique in a series managed in our department. MATERIAL AND METHOD Nineteen traumatic septic non-unions of the tibia were included in a retrospective single-center study between November 2007 and November 2014. All patients were followed up clinically and radiologically to assess bone union time. Multivariate analysis was used to identify factors influencing union. RESULTS The series comprised 4 women and 14 men (19 legs); mean age was 53.9 years. Vascularized flap transfer was required in 26% of cases before the first stage of treatment. All patients underwent a two-step procedure, with a mean interval of 7.9 weeks. Mean bone defect after the first step was 52.4mm. The bone graft was harvested from the iliac crest in the majority of cases (18/19). The bone was stabilized with an external fixator, locking plate or plaster cast after the second step. Mean follow-up was 34 months. Bony union rate was 89% (17/19), at a mean 16 months after step 2. Eleven patients underwent one or more (mean 2.1) complementary procedures. Severity of index fracture skin opening was significantly correlated with union time (Gustilo III vs. Gustilo I or II, p=0.028). A trend was found for negative impact of smoking on union (p=0.06). Bone defect size did not correlate with union rate or time. DISCUSSION The union rate was acceptable, at 89%, but with longer union time than reported in the literature. Many factors could explain this: lack of rigid fixation after step 2 (in case of plaster cast or external fixator), or failure to cease smoking. The results showed that the induced membrane technique is effective in treating tibial septic non-union, but could be improved by stable fixation after the second step and by cessation of smoking. LEVEL OF EVIDENCE IV, Retrospective study.
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Affiliation(s)
- Renaud Siboni
- Service de chirurgie orthopédique et traumatologique, CHU de Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Etienne Joseph
- Service de chirurgie orthopédique et traumatologique, CHU de Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Laurent Blasco
- Service de chirurgie orthopédique et traumatologique, CHU de Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Coralie Barbe
- Unité d'aide méthodologique, CHU de Robert-Debré, avenue du Général-Koenig, 51092 Reims cedex, France
| | - Odile Bajolet
- Laboratoire de bactériologie, virologie et hygiène, CHU de Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Saïdou Diallo
- Service de chirurgie orthopédique et traumatologique, CHU de Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - Xavier Ohl
- Service de chirurgie orthopédique et traumatologique, CHU de Maison-Blanche, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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23
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Zhao K, Wang Y, Lu M, Yao K, Xiao C, Zhou Y, Min L, Luo Y, Tu C. [Progress in repair and reconstruction of large segmental bone tumor defect in distal tibia]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1211-1217. [PMID: 30129350 DOI: 10.7507/1002-1892.201803007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To review the methods of repair and reconstruction of the large segmental bone tumor defect in distal tibia. Methods The related literature of repair and reconstruction of the large segmental bone tumor defect in disatal tibia were reviewed and analyzed from the aspects of the reserved ankle joint and the non-reserved ankle joint. Results The large segmental bone tumor defect in distak tibia is not rare in clinical. In addition to conventional allograft bone transplantation, vascularized autologous fibular transplantation, vascularized fibular allograft, inactivated tumor regeneration, distraction osteogenesis, and bone transport techniques; membrane-induced osteogenesis, artificial tumor stem prosthesis, three-dimensional printed metal trabecular prosthesis, ankle arthrodesis, artificial tumor ankle joint placement surgery are now gradually applied to the repair and reconstruction of large segmental bone defects in the distal tibia. Moreover, due to its long survival time, the function of reconstruction of the bone tumor defect in the distal tibia has also received increasing attention. Conclusion Although the ideal methods of repair and reconstruction of the large segmental bone tumor defect in the distal tibia has not yet been developed, great progress has been achieved. Recently, with the appearance of three-dimensional printing and various preoperative simulation techniques, personalized and precise therapy could become ture, but therapies for the large segmental bone tumor defect in the distal tibia still need to be further explored.
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Affiliation(s)
- Kun Zhao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yanling Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Minxun Lu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Kai Yao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Cong Xiao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yong Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Li Min
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yi Luo
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chongqi Tu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Morelli I, Drago L, George DA, Romanò D, Romanò CL. Managing large bone defects in children: a systematic review of the 'induced membrane technique'. J Pediatr Orthop B 2018; 27:443-455. [PMID: 28368930 DOI: 10.1097/bpb.0000000000000456] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Thirty years after its description by Masquelet in 1986, this is the first systematic review aiming to critically evaluate the 'induced membrane technique' effectiveness in achieving bone union in children. Only six papers fulfilled our inclusion criteria (54 patients). The relatively small number of reported cases did not allow a formal meta-analysis. The tibia was the most involved bone. Most frequent aetiologies were congenital pseudoarthrosis and tumour resections. Although effective in achieving bone healing in ∼91% of the patients (bone defects ≤24 cm long), the induced membrane technique was associated with a high rate of complications (54% of patients). LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ilaria Morelli
- Department of Reconstructive Surgery and Osteo-articular Infections C.R.I.O. Unit, I.R.C.C.S. Galeazzi Orthopaedic Institute
- University of Milan, Milan, Italy
| | - Lorenzo Drago
- Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopaedic Institute
- University of Milan, Milan, Italy
| | - David A George
- Department of Trauma and Orthopaedics, University College London Hospitals, London, UK
| | - Delia Romanò
- Department of Reconstructive Surgery and Osteo-articular Infections C.R.I.O. Unit, I.R.C.C.S. Galeazzi Orthopaedic Institute
| | - Carlo L Romanò
- Department of Reconstructive Surgery and Osteo-articular Infections C.R.I.O. Unit, I.R.C.C.S. Galeazzi Orthopaedic Institute
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25
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A pilot study: Alternative biomaterials in critical sized bone defect treatment. Injury 2018; 49:523-531. [PMID: 29153382 DOI: 10.1016/j.injury.2017.11.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Critical-sized bone defects are a significant challenge with limited effective reconstructive options. The Masquelet Technique (MT) offers a solution to help restore form and function. Although this technique has produced promising results; a clear mechanism has not been determined. Theories include that the induced membrane has osteogenic potential or the membrane acts as a physical barrier to prevent fibrous tissue ingrowth. We hypothesize the induced membrane acts primarily as a physical barrier and that a synthetic non-biological membrane will allow a comparable amount of bone volume in the defect site. METHODS Ten New Zealand rabbit forelimbs (n=10) were divided into three study groups. A critical sized defect of 3.5cm in the ulna was created. In the control group, a traditional MT was performed (n=4). The experimental arm varied by replacement of the PMMA with a non-porous (n=3) or porous (150um) (n=3) polytetrafluoroethylene (PTFE) membrane filled with allograft. Micro-CT analysis was done to compare bone volume to tissue volume ratios (BV/TV). Defect sections were examined histologically with alkaline phosphatase (ALP), tartrate-resistant acid phosphatase (TRAP) and von kossa (VK) staining. RESULTS MicroCT analysis comparing BV/TV between the control and experimental arms showed no difference. BV/TV of the MT was 7.77%±2.34 compared to porous 9.12%±3.66 and nonporous 9.76%±1.57 PTFE membranes (p1=0.761, p2=0.572, respectively). Histological sections from both samples stained for ALP and TRAP displayed osteoblastic and osteoclastic activity. There was a higher amount of ALP and TRAP positively stained cells near the native bone ends in comparison to the center of the defect, in both sample types. CONCLUSION AND SIGNIFICANCE Replacing the induced membrane from the MT with a synthetic PTFE membrane illustrated that the membrane acts primarily as a functional barrier. Compared to the induced membrane, the PTFE membrane was able to display similar osteointegrative properties. These results allow for future optimization of the technique with the potential to further streamline towards a single stage procedure.
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26
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Steiger CN, Journeau P, Lascombes P. The role of the periosteal sleeve in the reconstruction of bone defects using a non-vascularised fibula graft in the pediatric population. Orthop Traumatol Surg Res 2017; 103:1115-1120. [PMID: 28780005 DOI: 10.1016/j.otsr.2017.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 04/02/2017] [Accepted: 05/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Following resection of large benign bone tumors surgeons are confronted with bone defects severely affecting the stability of a limb. To restore the mechanical continuity of the bone different treatment methods using bone grafts have been described. In pediatric patients the thick periosteal sleeve is thought to contribute to bone formation. HYPOTHESIS An intact periosteal sleeve is crucial in bone remodelling around a non-vascularised fibular graft used to bridge large bone defects. METHODS We present a treatment technique applied in 6 cases comprising of subperiosteal tumor resection at the diaphyseal or metaphyseal level of long bones followed by defect bridging with a non-vascularised fibula graft inserted into the periosteal sleeve of the resection zone. Elastic intramedullary nails or plates were used for stabilisation. RESULTS Due to the intact periosteum at the resection site bone integration occurred quickly and full remodelling was seen in all but one case. Tumor location in this case was at the metaphyseal level resulting in tumor resection at the growth plate. Although bone healing at the distal resection site was seen after a few weeks proximal consolidation was only partial. Full reconstitution of the fibula in the remaining periosteal sleeve was seen in 5 cases, partial reconstitution in 1 case. DISCUSSION In the pediatric patient, the described technique is an effective and reliable treatment method for large benign bone tumors requiring resection. However, great diameter discrepancy of the donor and recipient site and a thin periosteum can be a limiting factor for its application. LEVEL OF EVIDENCE Level IV clinical study.
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Affiliation(s)
- C N Steiger
- Service d'orthopédie pédiatrique, département de l'enfant et de l'adolescent, hôpitaux universitaires de Genève, rue Willy Donzé 6, 1205 Genève, Switzerland.
| | - P Journeau
- Service d'orthopédie pédiatrique, hôpital d'enfants de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy, France
| | - P Lascombes
- Service d'orthopédie pédiatrique, département de l'enfant et de l'adolescent, hôpitaux universitaires de Genève, rue Willy Donzé 6, 1205 Genève, Switzerland
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27
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Barla M, Polirsztok E, Peltié E, Jouve JL, Legré R, Dautel G, Barbary S, Journeau P. Free vascularised fibular flap harvesting in children: An analysis of donor-site morbidity. Orthop Traumatol Surg Res 2017; 103:1109-1113. [PMID: 28578099 DOI: 10.1016/j.otsr.2017.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 04/12/2017] [Accepted: 05/04/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The free vascularised fibular flap (FVFF) is widely used to treat bone defects, although it must be harvested from a healthy site. The objective of this study was to assess clinical morbidity and radiological changes at the FVFF donor site in children. HYPOTHESIS Distal fibular stabilisation using a tibial strut decreases the prevalence of valgus ankle deformity. MATERIAL AND METHOD Thirty-one children managed at two centres between 1994 and 2014 were included. Mean age was 8.9 years (range, 2-14 years) and mean follow-up was 6.6 years (range, 2-21 years). Early and delayed complications were evaluated. RESULTS Of the 17 early complications, 82.4% resolved fully within 7 months. Valgus ankle deformity developed in 6 (19.4%) patients. Age-residual fibula index under 16 was not significantly associated with valgus ankle deformity, although the P-value was borderline (P<0.058). Residual distal fibula length did not predict valgus ankle deformity. Three techniques were used for fibular reconstruction: syndesmotic screw, tibial strut, and both. None of these techniques prevented the occurrence of valgus ankle deformity. DISCUSSION Clinical donor-site morbidity after FVFF harvesting, although noticeable, usually resolved promptly. Taken alone, an age-residual fibula index under 16 did not predict valgus ankle deformity. We recommend a distal tibio-fibular quadricortical syndesmotic screw or combined syndesmotic screw-tibial strut fixation to prevent valgus ankle deformity, which is common when a tibial strut is used alone. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- M Barla
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - E Polirsztok
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - E Peltié
- Service d'orthopédie pédiatrique, hôpital La Timone, CHU de Marseille, 13385 Marseille, France
| | - J-L Jouve
- Service d'orthopédie pédiatrique, hôpital La Timone, CHU de Marseille, 13385 Marseille, France
| | - R Legré
- Service de chirurgie plastique et reconstructrice, hôpital La Timone, CHU de Marseille, 13385 Marseille, France
| | - G Dautel
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - S Barbary
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - P Journeau
- Service d'orthopédie et traumatologie infantile, hôpital d'enfants de Brabois, CHU de Nancy, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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Treatment of critical-sized bone defects: clinical and tissue engineering perspectives. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 28:351-362. [PMID: 29080923 DOI: 10.1007/s00590-017-2063-0] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/08/2017] [Indexed: 12/11/2022]
Abstract
Critical-sized bone defects are defined as those that will not heal spontaneously within a patient's lifetime. Current treatment options include vascularized bone grafts, distraction osteogenesis, and the induced membrane technique. The induced membrane technique is an increasingly utilized method with favorable results including high rates of union. Tissue engineering holds promise in the treatment of large bone defects due to advancement of stem cell biology, novel biomaterials, and 3D bioprinting. In this review, we provide an overview of the current operative treatment strategies of critical-sized bone defects as well as the current state of tissue engineering for such defects.
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Vigouroux F, Mezzadri G, Parot R, Gazarian A, Pannier S, Chotel F. Vascularised fibula or induced membrane to treat congenital pseudarthrosis of the Tibia: A multicentre study of 18 patients with a mean 9.5-year follow-up. Orthop Traumatol Surg Res 2017; 103:747-753. [PMID: 28559144 DOI: 10.1016/j.otsr.2017.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 04/05/2017] [Accepted: 05/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study was to compare outcomes of two surgical techniques used to treat congenital pseudarthrosis of the tibia (CPT), the induced membrane technique (IM) and the transfer of the contralateral vascularised fibula (VF). HYPOTHESIS The IM technique produces similar outcomes to those of VF grafting in terms of healing and function, while being simpler and having a lower complication rate. MATERIAL AND METHOD This retrospective multicentre study included 18 patients with a mean age of 2.8 years at surgery. Among them, 11 had neurofibromatosis type 1 (NF1). The IM technique was used in 10 patients and VF grafting in 8 patients. Mean follow-up was 9.5 years (range: 5-15 years). RESULTS The two groups showed no significant differences for healing or the occurrence of complications such as limb length discrepancy and residual malalignment. Two patients required amputation, one in each group. The mean number of surgical procedures per patient was 4.7 in the IM group and 5 in the VF group. DISCUSSION Outcomes are similar with the two techniques. Although VF grafting theoretically involves a single stage, the mean number of surgical procedures was not lower than after the IM technique. The IM technique was associated with lower risks of complications and residual donor site abnormalities. Regardless of the reconstruction technique, the quality of the initial bone resection and internal fixation, particularly regarding alignment, is of the utmost importance. LEVEL OF EVIDENCE IV, comparative retrospective study.
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Affiliation(s)
- F Vigouroux
- Service de chirurgie orthopédique pédiatrique, hôpital Femme-Mère-Enfant, Bron, France.
| | - G Mezzadri
- Service de chirurgie orthopédique pédiatrique, hôpital Femme-Mère-Enfant, Bron, France
| | - R Parot
- Service de chirurgie orthopédique pédiatrique, hôpital Femme-Mère-Enfant, Bron, France
| | - A Gazarian
- Service de chirurgie orthopédique pédiatrique, hôpital Femme-Mère-Enfant, Bron, France
| | - S Pannier
- Service de chirurgie orthopédique pédiatrique, hôpital Necker-Enfants-Malades, université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - F Chotel
- Service de chirurgie orthopédique pédiatrique, hôpital Femme-Mère-Enfant, Bron, France
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Kombate NK, Walla A, Ayouba G, Bakriga BM, Dellanh YY, Abalo AG, Dossim AM. Reconstruction of traumatic bone loss using the induced membrane technique: preliminary results about 11 cases. J Orthop 2017; 14:489-494. [PMID: 28839352 DOI: 10.1016/j.jor.2017.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 06/22/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The use of Masquelet technique is a serious option to consider for biologic reconstruction of severe bone loss. Here is exposed a continuous and prospective study on bone loss management using that technique. The aims of this study were to assess epidemiology of bone loss due either to trauma or to non-unions and to give preliminary results. PATIENTS AND METHODS It was a prospective study from April 2015 to december 2016 involving patients treated using the induced membrane technique for a diaphyseal bone defect due either to trauma or non-unions. AO plates or Orthofix external fixators were used for osteosynthesis. Bone healing was radiologically assessed and any complications were listed. RESULTS During the study period, 11 patients were treated using the induced membrane technique. There were 8 males and 3 females. Their mean age was 40.45 years (21-59). The skeletal segments concerned were 2 humerus, 6 femurs and 3 tibias with a mean bone defect length of 4,45 cm (2.5-8). The delay between reconstruction and trauma was 8 months (20 days - 3 years). After a mean follow-up of 6.54 months (3-11) six patients presented a good radiological healing (4 femurs, 2 humerus) whereas in four patients, autograft osteointegration was still ongoing (2 femurs, 2 tibias). A tibia secondary infection was observed in a patient with the graft partial resorption. In another patient, an initial gangrene lead to a leg amputation. CONCLUSION The induced membrane technique is an excellent option for bone defect reconstruction compared to other usual bone graft techniques. It helped us to manage large bone loss in various skeletal segments.
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Affiliation(s)
| | - Atchi Walla
- Orthopedic and Traumatology Department of Sylvanus Olympio Teaching Hospital, Lome-Togo, P.O Box 57, Africa
| | - Gamal Ayouba
- Orthopedic and Traumatology Department of Sylvanus Olympio Teaching Hospital, Lome-Togo, P.O Box 57, Africa
| | - B Moïse Bakriga
- Orthopedic and Traumatology Department of Sylvanus Olympio Teaching Hospital, Lome-Togo, P.O Box 57, Africa
| | - Yaovi Yannick Dellanh
- Orthopedic and Traumatology Department of Sylvanus Olympio Teaching Hospital, Lome-Togo, P.O Box 57, Africa
| | - Anani Grégoire Abalo
- Orthopedic and Traumatology Department of Sylvanus Olympio Teaching Hospital, Lome-Togo, P.O Box 57, Africa
| | - Assang Michel Dossim
- Orthopedic and Traumatology Department of Afagnan Saint-Jean-de- Dieu Hospital, Lome-Togo, P.O Box 1170, Africa
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Tong K, Zhong Z, Peng Y, Lin C, Cao S, Yang Y, Wang G. Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis. Injury 2017; 48:1616-1622. [PMID: 28408083 DOI: 10.1016/j.injury.2017.03.042] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study was to compare the effectiveness of Masquelet technique versus Ilizarov bone transport in the treatment of lower extremity bone defects following posttraumatic osteomyelitis. PATIENTS AND METHODS We retrospectively reviewed 39 patients who had been treated at our department for lower extremity bone defects following posttraumatic osteomyelitis. They were 30 males and 9 females with a mean age of 39.18 (range, 12-63 years). The infected bone defects involved 26 tibias and 13 femurs. The mean length of the bone defects after radical debridement was 6.76cm (range, 2.7-15.7cm). Masquelet technique (MT, group A) was used in 20 patients and Ilizarov bone transport (IBT, group B) in 19 ones. The measurements were bone outcomes (union, deformity, infection and leg-length discrepancy) and functional outcomes (significant limping, joint contracture, soft tissue dystrophy, pain and inactivity). RESULTS The mean follow-up after removal of the apparatus was 25.26 months (range, 14-51 months). The mean finite fixator time was 10.15 months (range, 8-14 months) in group A versus 17.21 months (range, 11-24 months) in group B. The bone outcomes were similar between groups A and B [excellent (5 vs. 7), good (10 vs.9), fair (4 vs. 2) and poor (1 vs. 1)]; group A showed better functional outcomes than group B [excellent (8 vs. 3), good (9 vs. 6), fair (3 vs. 8) and poor (0 vs. 2)]. CONCLUSIONS In the treatment of segmental lower extremity bone defects following posttraumatic osteomyelitis, both IBT and MT can lead to satisfactory bone results while MT had better functional results, especially in femoral cases. IBT should be preferred in cases of limb deformity and MT may be a better choice in cases of periarticular bone defects.
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Affiliation(s)
- Kai Tong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Ziyi Zhong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Yulan Peng
- Operating Room, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430000, PR China
| | - Chuangxin Lin
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, PR China
| | - Shenglu Cao
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - YunPing Yang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China
| | - Gang Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, PR China.
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Aurégan JC, Bégué T, Rigoulot G, Glorion C, Pannier S. Success rate and risk factors of failure of the induced membrane technique in children: a systematic review. Injury 2016; 47 Suppl 6:S62-S67. [PMID: 28040089 DOI: 10.1016/s0020-1383(16)30841-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The induced membrane technique was designed by Masquelet et al. to address segmental bone defects of critical size in adults. It has been used after bone defects of traumatic, infectious and tumoral origin with satisfactory results. Recently, it has been used in children but, after an initial enthusiasm, several cases of failure have been reported. The purpose of this study was to assess the success rate and the risk factors of failure of the induced membrane for children. We conducted a systematic review of all the studies reporting the results of the induced membrane technique to address bone defects of critical size in children. Our primary outcome was the success rate of the technique defined as a bone union before any iterative surgery. Our secondary outcomes were the complications and the risk factors of failure. We searched Medline via Pubmed, EMBASE and the Cochrane Library. Twelve studies, including 69 patients, met the inclusion criteria. There were 41 boys and 28 girls. Mean age at surgery was 10 years. Mean size of resection was 12.38 cm and the mean time between the two stages was 5.86 months. Mean rate of bone union after the two stages of the induced membrane technique was 58% (40/69) but this rate increased to 87% after revision surgeries (60/69). Main complications were non-unions (19/69), lysis of the graft (6/69) and fractures of the bone graft (6/69). Only 1/69 deep infection was reported. Other non specific complications were regularly reported such limb length discrepancies, joint stiffness and protruding wires. Risk factor of failure that could be suspected comprised the resection of a malignant tumour, a bone defect located at the femur, a wide resection, a long time between the two stages, an unstable osteosynthesis and a bone graft associating autograft to other graft materials. The induced membrane technique is suitable for bone defects of critical size in children. It is a reliable technique with no need of micro vascular surgery. However, we found several risk factors of failure for the use of the induced membrane technique to address segmental bone defect of critical size in children.
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Affiliation(s)
- Jean-Charles Aurégan
- Department of Orthopaedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, University Paris Sud, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
| | - Thierry Bégué
- Department of Orthopaedic Surgery and Traumatology, Antoine Béclère Hospital, AP-HP, University Paris Sud, 157 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Guillaume Rigoulot
- Department of Orthopaedic Paediatrics, Necker - Enfants Malades Hospital, AP-HP, University Paris-Descartes, 149 rue de Sèvres, 75015, Paris, France
| | - Christophe Glorion
- Department of Orthopaedic Paediatrics, Necker - Enfants Malades Hospital, AP-HP, University Paris-Descartes, 149 rue de Sèvres, 75015, Paris, France
| | - Stéphanie Pannier
- Department of Orthopaedic Paediatrics, Necker - Enfants Malades Hospital, AP-HP, University Paris-Descartes, 149 rue de Sèvres, 75015, Paris, France
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Yeganeh A, Mahmodi M, Farahini H, Moghtadaei M. Short-term Outcomes of Induced Membrane Technique in Treatment of Long Bone Defects in Iran. Med Arch 2016; 70:284-287. [PMID: 27703290 PMCID: PMC5034987 DOI: 10.5455/medarh.2016.70.284-287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/18/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction: Severe defects in long bones can be caused by several factors such as trauma that lead to open wound and secondary infections after surgery. Induced membrane technique is one of the therapeutic strategies that can be used for these patients. Due to importance of this method and lack of information about this technique in Iran. Aim: this study was performed to investigate technical strengths and weakness of induced membrane technique. Material and Methods: This case series study conducted on 21 patients with bone defects in the femur and tibia and metatarsal bones referred to orthopedic clinic of Rasoul Akram Hospital, Tehran, Iran, for induced membrane surgery in 2012-2015. Demographic and clinical data were obtained using history, clinical examinations and observations for each patient. Union achievement was the main outcome of this study, which was confirmed by radiographic findings and physical examination. Obtained data was analyzed by SPSS ver. 16. Results: All patients were male except one and their mean age was 30.52 years old. Bone defects were in tibia, femur and metatarsus in 9, 9 and 3 patients, respectively. Three patients received soft tissue reconstruction with flap before induced membrane surgery. Age, defects size, cigarette addiction and drug use and delay to start the treatment had no significant effect on union status. In total, 90% of patients had successful surgery. Conclusion: using induced membrane technique in patients with defects in their long bone such as tibia, femur and metatarsus would lead to high success for reconstruction.
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Affiliation(s)
- Ali Yeganeh
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mani Mahmodi
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Hosein Farahini
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Mehdi Moghtadaei
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
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Use of a formwork in the induced membrane technique: Relevance and technical note. HAND SURGERY & REHABILITATION 2016; 35:165-167. [DOI: 10.1016/j.hansur.2016.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 02/19/2016] [Accepted: 02/24/2016] [Indexed: 11/21/2022]
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Wang X, Luo F, Huang K, Xie Z. Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis. Bone Joint Res 2016; 5:101-5. [PMID: 27033845 PMCID: PMC4852786 DOI: 10.1302/2046-3758.53.2000487] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/28/2016] [Indexed: 01/07/2023] Open
Abstract
Objectives Induced membrane technique is a relatively new technique in the reconstruction of large bone defects. It involves the implantation of polymethylmethacrylate (PMMA) cement in the bone defects to induce the formation of membranes after radical debridement and reconstruction of bone defects using an autologous cancellous bone graft in a span of four to eight weeks. The purpose of this study was to explore the clinical outcomes of the induced membrane technique for the treatment of post-traumatic osteomyelitis in 32 patients. Methods A total of 32 cases of post-traumatic osteomyelitis were admitted to our department between August 2011 and October 2012. This retrospective study included 22 men and ten women, with a mean age of 40 years (19 to 70). Within this group there were 20 tibias and 12 femurs with a mean defect of 5 cm (1.5 to 12.5). Antibiotic-loaded PMMA cement was inserted into the defects after radical debridement. After approximately eight weeks, the defects were implanted with bone graft. Results The patients were followed for 27.5 months (24 to 32). Radiographic bone union occurred at six months for 26 cases (81%) and clinical healing occurred in 29 cases (90%) at ten months. A total of six cases had a second debridement before bone grafting because of recurrence of infection and one patient required a third debridement. No cases of osteomyelitis had recurred at the time of the last follow-up visit. Conclusion The induced membrane technique for the treatment of post-traumatic osteomyelitis is a simple, reliable method, with good early results. However, there are many challenges in determining the scope of the debridement, type of limb fixation and source of bone graft to be used. Cite this article: Dr Z. Xie. Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis. Bone Joint Res 2016;5:101–105. DOI: 10.1302/2046-3758.53.2000487.
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Affiliation(s)
- X Wang
- Southwest Hospital, Third Military Medical University, Gaotanyan No.30, Chongqing 400038, The People's Republic of China
| | - F Luo
- Southwest Hospital, Third Military Medical University, Gaotanyan No.30, Chongqing 400038, The People's Republic of China
| | - K Huang
- Southwest Hospital, Third Military Medical University, Gaotanyan No.30, Chongqing 400038, The People's Republic of China
| | - Z Xie
- Southwest Hospital, Third Military Medical University, Gaotanyan No.30, Chongqing 400038, The People's Republic of China
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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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Gouron R. Surgical technique and indications of the induced membrane procedure in children. Orthop Traumatol Surg Res 2016; 102:S133-9. [PMID: 26774902 DOI: 10.1016/j.otsr.2015.06.027] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/21/2015] [Accepted: 06/02/2015] [Indexed: 02/07/2023]
Abstract
The induced membrane technique is now quite adaptable to segmental bone reconstruction in children. This technique is much the same as the technique used in adults. A cement spacer is interposed, and in a second operating phase, occurring 6 weeks after the interposition of the spacer, the cement is removed and a morselized corticocancellous graft is installed in the induced membrane that had formed around the cement. Graft expansion using allograft chips should not exceed 30% of the total volume. An additional autograft strut is useful in the reconstruction of long femoral or metaphyseal-diaphyseal tibial defects. Despite the apparent simplicity of this technique, it requires rigorous technique during cement sleeving and to stabilize the defect to prevent nonunion, stabilization device loosening, or resorption of the graft, the main complications. This technique is now becoming the gold standard for bone reconstruction in trauma and septic bone surgery. In pediatrics, the Masquelet technique is now mainly used in the context of cancer surgery reconstructions. Constraints related to chemotherapy have led to deferral of the graft, which is therefore empirically performed 8 weeks after the last course of chemotherapy. Congenital anomalies, including congenital pseudarthrosis, may now be treated using this technique, replacing long and difficult conventional treatment. A longer follow-up would be necessary to assess and confirm the superiority of this pediatric reconstruction technique.
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Affiliation(s)
- R Gouron
- Service d'orthopédie pédiatrique, groupe hospitalier Sud, CHU d'Amiens, 80054 Amiens cedex 1, France.
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de Monès E, Schlaubitz S, Oliveira H, d'Elbée JM, Bareille R, Bourget C, Couraud L, Fricain JC. Comparative study of membranes induced by PMMA or silicone in rats, and influence of external radiotherapy. Acta Biomater 2015; 19:119-27. [PMID: 25770925 DOI: 10.1016/j.actbio.2015.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 02/27/2015] [Accepted: 03/05/2015] [Indexed: 12/11/2022]
Abstract
The induced membrane technique has been used for long bone defect reconstruction after traumatism. One of the major drawbacks of this method is the difficult removal of the polymethyl methacrylate spacer after membrane formation. We therefore replaced the stiff PMMA spacer with a semi-flexible medical grade silicone spacer. This study aimed to compare subcutaneously formed membranes, induced by PMMA and silicone, in the irradiated or not irradiated areas within 28 rats that received the spacers. Histological analysis was performed to evaluate the composition of the membrane and to quantify the amount of vessels. Histomorphometric measurements were used to evaluate membranes' thickness, while fibrosis and inflammation were scored. The expression of VEGF and BMP-2 in lysates of the crushed membranes was determined by Western blotting. ALP expression was analyzed in HBMSC cultures in contact with the same lysates. Non-irradiated membranes induced by the two spacer types were non-inflammatory, fibrous and organized in layers. Irradiation did not change the macroscopic properties of membranes that were induced by silicone, while PMMA induced membranes were sensitive to the radiotherapy, resulting in thicker, strongly inflammatory membranes. Irradiated membranes showed an overall reduced osteogenic potential. Medical grade silicone is safe for the use in radiotherapy and might therefore be of great advantage for patients in need of cancer treatment.
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Affiliation(s)
- Erwan de Monès
- INSERM U1026, Tissue Bioengineering, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Univ. Bordeaux, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Department of Otolaryngology - Head and Neck Surgery, Univ. Bordeaux, Place Amélie Raba Léon, F-33000 Bordeaux, France
| | - Silke Schlaubitz
- Univ. Bordeaux, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Bordeaux University Hospital, CIC 1401, PTIB, Xavier Arnozan Hospital, Avenue Haut Lévêque, F-33000 Bordeaux, France
| | - Hugo Oliveira
- INSERM U1026, Tissue Bioengineering, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Univ. Bordeaux, 146 rue Léo-Saignat, F-33000 Bordeaux, France
| | - Jean-Marie d'Elbée
- INSERM U1026, Tissue Bioengineering, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Univ. Bordeaux, 146 rue Léo-Saignat, F-33000 Bordeaux, France
| | - Reine Bareille
- INSERM U1026, Tissue Bioengineering, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Univ. Bordeaux, 146 rue Léo-Saignat, F-33000 Bordeaux, France
| | - Chantal Bourget
- INSERM U1026, Tissue Bioengineering, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Univ. Bordeaux, 146 rue Léo-Saignat, F-33000 Bordeaux, France
| | - Lionel Couraud
- Bordeaux University Hospital, CIC 1401, PTIB, Xavier Arnozan Hospital, Avenue Haut Lévêque, F-33000 Bordeaux, France
| | - Jean-Christophe Fricain
- INSERM U1026, Tissue Bioengineering, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Univ. Bordeaux, 146 rue Léo-Saignat, F-33000 Bordeaux, France; Department of Dentistry, Univ. Bordeaux, Place Amélie Raba Léon, F-33000 Bordeaux, France.
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Abstract
BACKGROUND Surgical reconstruction of segmental skeletal defects represents a true challenge for the orthopedic surgeons. Recently, Masquelet et al. described a two-stage technique for reconstruction of bone defects, known as the induced membrane technique. The aim of this study is to assess the results of the induced membrane technique in the management of segmental skeletal defects resulting from debridement of bone infection. MATERIALS AND METHODS Seventeen patients with segmental skeletal defects were treated in our institution by the induced membrane technique. The average age of the patients was 43 years (range 26- 58 years). The causes of the defects were infected gap nonunion in 12 cases and debridement of osteomyelitis in 5 cases. The defects were located in the tibia (n = 13) and the femur (n = 4). The mean defect was 7 cm (range 4 cm - 11 cm). All cases were treated by the induced membrane technique in two-stages. RESULTS Bone union happened in 14 patients. The limb length discrepancy did not exceed 2.5 cm in the healed cases. The mean time of healing was 10 months (range 6-19 months). The complications included nonunion of the graft in five cases, failure of graft maturation in two cases, reactivation of infection in two cases and refracture after removal of the frame in one case. These complications were managed during the course of treatment and they did not affect the final outcome in all patients except three. CONCLUSION The induced membrane technique is a valid option for the management of segmental skeletal defects. It is a simple and straight forward procedure, but the time required for growth and maturation of the graft is relatively long.
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Affiliation(s)
- Barakat Sayed El-Alfy
- Department of Orthopedic Surgery, Mansoura University, Egypt,Address for correspondence: Dr. Barakat Sayed El-Alfy, Department of Orthopedic Surgery, Faculty of Medicine, Mansoura University, Egypt. E-mail:
| | - Ayman M Ali
- Department of Orthopedic Surgery, Mansoura University, Egypt
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40
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Abstract
From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance in the treatment of musculoskeletal sarcomas. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality and the unique challenges of reconstruction in skeletally immature individuals are also discussed. Striking the right balance between adequate resection, while yet retaining or reconstructing tissue for acceptable function and cosmesis is a difficult task. Complications are not uncommon and patients and their families need to be counseled regarding the potential setbacks that may occur in the course of their eventual road to recovery, Limb salvage entails a well orchestrated effort involving various specialties and better outcomes are likely to be achieved with centralization of expertise at regional centers.
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Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India,Address for correspondence: Prof. Ajay Puri, Room No. 45, Tata Memorial Hospital, E. Borges Road, Parel, Mumbai - 400 012, Maharashtra, India. E-mail:
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Venkatramani H, Sabapathy SR, Dheenadayalan J, Devendra A, Rajasekaran S. Reconstruction of post-traumatic long segment bone defects of the lower end of the femur by free vascularized fibula combined with allograft (modified Capanna’s technique). Eur J Trauma Emerg Surg 2014; 41:17-24. [DOI: 10.1007/s00068-014-0451-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/08/2014] [Indexed: 01/16/2023]
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Abstract
The treatment of musculoskeletal sarcomas has made vast strides in the last few decades. From an era where amputation was the only option to the current day function preserving resections and complex reconstructions has been a major advance. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow early subsequent adjuvant therapy, optimising the aesthetic outcome and preservation of functional capability with early return to function. This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in these tumors and summarises the current modalities and recent developments relevant to reconstruction after limb salvage. The rationale of choice of a particular resection modality, the unique challenges of reconstruction in skeletally immature individuals and the impact of adjuvant modalities like chemotherapy and radiotherapy on surgical outcomes are also discussed.
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Affiliation(s)
- Ajay Puri
- Department of Orthopaedic Oncology Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Gouron R, Petit L, Boudot C, Six I, Brazier M, Kamel S, Mentaverri R. Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique. J Tissue Eng Regen Med 2014; 11:382-389. [PMID: 24919776 DOI: 10.1002/term.1921] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 02/19/2014] [Accepted: 04/24/2014] [Indexed: 01/27/2023]
Abstract
In 2000, Masquelet reported a long bone reconstruction technique using an induced membrane formed around a polymethylmethacrylate (PMMA) spacer placed in the defect with appropriate stabilization followed by secondary bone graft after PMMA removal. This reconstruction procedure allows rapid and safe bone reformation for septic, traumatic, neoplastic or congenital bone defects. A rat model of the Masquelet technique was developed to further characterize the biological activities of this induced membrane. Our model allows healing of a critical-sized femoral defect (8 mm) by means of this procedure over a period of 18 weeks. Comparison of induced membranes obtained 3, 4, 5 and 6 weeks after PMMA insertion indicated that this tissue changes over time. Several mineralization spots and bone cells were observed in contact with the PMMA, when assessed by Alizarin Red, Von Kossa, Alkaline phosphatase and Tartrate-resistant acid phosphatase staining of the membranes. CTR (calcitonin receptor)- and RANK (Receptor Activator of Nuclear factor Kappa B)- positive mononuclear cells were detected in the induced membrane, confirming the presence of osteoclasts in this tissue. These cells were observed in a thin, highly cellular layer in the induced membrane in contact with the PMMA. Together, these findings suggest that the membrane is able to promote osteointegration of autologous corticocancellous bone grafts during the Masquelet technique by creating local conditions that may be favourable to graft bone remodelling and osteointegration. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Richard Gouron
- INSERM U-1088, Amiens, France
- Department of Paediatric Orthopaedic Surgery, Jules Verne University of Picardie and Amiens University Medical Centre, Amiens, France
| | | | | | | | - Michel Brazier
- INSERM U-1088, Amiens, France
- Bone Biology and Endocrine Division, Jules Verne University of Picardie and Amiens University Medical Centre, Amiens, France
| | - Said Kamel
- INSERM U-1088, Amiens, France
- Biochemistry Division, Jules Verne University of Picardie and Amiens University Medical Centre, Amiens, France
| | - Romuald Mentaverri
- INSERM U-1088, Amiens, France
- Bone Biology and Endocrine Division, Jules Verne University of Picardie and Amiens University Medical Centre, Amiens, France
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Bone defect reconstruction in children using the induced membrane technique: a series of 14 cases. Orthop Traumatol Surg Res 2013; 99:837-43. [PMID: 24070692 DOI: 10.1016/j.otsr.2013.05.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 04/15/2013] [Accepted: 05/13/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In pediatrics, Masquelet's induced membrane reconstructive technique has mainly been used in the context of cancer surgery reconstruction or congenital pseudarthrosis of the tibia. This retrospective study consisted of a series of pediatric patients where bone defects were reconstructed with this technique. MATERIALS AND METHODS Between 2006 and 2011, 14 children underwent bone reconstruction using this technique in the context of trauma, tumor resection or congenital pseudarthrosis. The mean age was 10.6years (range: 12 to 17years) at the time of reconstruction. The length of the defect to be reconstructed relative to the length of the bone (index of reconstruction, expressed as a percentage) and bone healing was evaluated on standard radiographs. Complications were recorded. RESULTS The mean index of reconstruction was 32.8% (range: 13.9 to 51%). The mean follow-up was 30months (range: 1 to 63). Bone union was achieved in 9.5months (range: 2 to 25). Complications mainly consisted of non-union in 35% of cases, which consolidated after grafting and rigid fixation. Two cases of wound dehiscence were noted. Massive graft resorption occurred in a single case. DISCUSSION A technical error was identified in each non-union case (insufficient cement overlap of the bone ends or fixation not stiff enough). These long defects required a large volume of autograft, which constitutes the limiting factor especially in very young children. We used allograft bone chips or a tibial bone strut to increase the graft volume in the largest reconstructions. In this pediatric-only series, an average of one-third of the bone length was successfully reconstructed. Although the technique appears simple, it must be performed rigorously to ensure the cement sufficiently overlaps the bone ends and the defect is properly stabilized to prevent non-union, which is the main complication. LEVEL OF EVIDENCE Level IV (retrospective study).
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Induced-membrane femur reconstruction after resection of bone malignancies: three cases of massive graft resorption in children. Orthop Traumatol Surg Res 2013; 99:479-83. [PMID: 23608487 DOI: 10.1016/j.otsr.2013.01.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 11/13/2012] [Accepted: 01/02/2013] [Indexed: 02/02/2023]
Abstract
Bone reconstruction after surgical resection of bone malignancies in children remains a difficult challenge. Induced-membrane reconstruction as described by Masquelet et al. was originally reported in traumatic or septic bone defects and is now adapted to this field. We report here three cases of massive femoral graft resorption requiring surgical revision in two boys aged 3 and 6 years and a 9-year-old girl. Hypotheses include the long delay between the two stages, nature of the bone graft, high varus loads specific to this location, and lack of stability of the fixation. This technique has recently provided promising preliminary results when applied to the field of bone tumours. However, reconstruction of the femur seems to be specifically associated with a risk of graft resorption. Identification of the origin of this major complication is needed to amend the technique or its indications.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2013. [DOI: 10.1097/bco.0b013e31829684d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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