Bone Transport Through Induced Membrane Versus Conventional Bone Transport in Management of Infected Long-Bone Defects of Lower Limbs: A Randomized Controlled Trial

Abstract

Objectives: To compare bone transport through induced membrane (BTM) and conventional bone transport (BT) regarding docking site union and infection recurrence in the management of infected long-bone defects. Design: Prospective, randomized, controlled study. Setting: Tertiary-level center. Participants: Thirty patients with infected nonunited long-bone fractures of lower limbs were included. Intervention: Fifteen patients were treated by BTM in group A, and 15 patients were treated by BT in group B. Outcome Measurements: The outcome measures were external fixation time, external fixation index, and docking time. Bone and functional outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov scoring system. Postoperative complications were evaluated according to the Paley classification. Results: The mean docking time was significantly lower in the BTM group than in the BT group (3.6 ± 0.82 months vs. 4.8 ± 0.86 months, respectively; P value 0.001). Docking site nonunion and infection recurrence were significantly lower in the BTM group than in the BT group (0% vs. 40%; P value 0.02 and 0% vs. 33.3%; P value 0.04, respectively), with no significant difference in the external fixation index (P value 0.08). Conclusions: This is the first prospective, randomized, controlled study comparing BTM and BT techniques, showing that BTM had significantly faster docking site union, lower incidence of postoperative complications including docking site nonunion and infection recurrence rates, and lower number of additional procedures needed at the expense of 2-staged operation in comparison with BT. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Trauma

“…Both have their advantages; in this small randomized trial, investigators from Cairo (Egypt) asked the question if there is a place for a novel hybrid approach that may offer several clinical advantages. 5 The study aimed to explore the benefits of a two-stage procedure involving BT through an induced membrane (BTM), compared to the conventional single-stage BT. While this is not a unique concept, and cases and technique descriptions have been around for a while, this is the first (to our knowledge) prospective (let alone randomized) evaluation.…”