Is the Induced-membrane Technique Successful for Limb Reconstruction After Resecting Large Bone Tumors in Children?

Abstract

Background Resection of primary malignant tumors often creates large bony defects. In children, this creates reconstructive challenges, and many options have been described for limb salvage in this setting. Studies have supported the use of an induced-membrane technique after placement of a cement spacer to aid in restoration of bone anatomy. Questions/purposes We asked: (1) What complications are associated with the induced-membrane technique? (2) How often is bone healing achieved after resection greater than 15 cm using this technique? (3) What is the functional outcome of patients treated with this technique?Methods We performed a retrospective evaluation of eight patients with a mean age of 13.3 years (range, 11-17 years) treated for a malignant bone tumor between 2002 and 2012 at our centers. The primary malignant tumors involved the proximal humerus, femur, and tibia. All patients were treated using the induced-membrane technique after a resection with mean bone loss of 18 cm (range, 16-23 cm). The general indication for using the induced-membrane technique during this time was a large diaphyseal defect after resection of the tumor. In addition to using cancellous graft as with the original technique, in the current patients an autogenous nonvascularized fibula was used to enhance stability. The patients were assessed at the last followup using the Musculoskeletal Tumor Society (MSTS) scoring system. Mean followup was 47.1 months (range, 24-120 months), and none of the patients were lost to followup before 2 years. Results A total of four unplanned reoperations were performed in these eight patients. A fracture of the reconstruction occurred in three patients and all were treated successfully, two with surgery and one with immobilization. Bone fusion was obtained in all patients within 4 to 8 months (mean, 5.6 months) after the reconstruction. The mean healing index was 0.31 month/cm of reconstruction (range, 0.23-0.5 month/cm). At last followup, the mean MSTS score was 74% (range, 67%-80%). Conclusions Our findings suggest that the modified induced-membrane technique is a reasonable alternative to other limb reconstruction techniques for bone tumors in children and has the advantage of not requiring a bone bank or an expensive metal prosthesis. Although more patients will be needed to substantiate our findings, it has become a standard part of our arsenal in the treatment of large bone defects after resection of pediatric primitive bone tumors.

Single-cortex is better than double-cortex in fibula grafts for large tibia bone defect in a 2-year-old child

“…While many techniques can be used to treat bone defects in adult, it is still a great challenge for infants or small patients at early ages. [ 2 ] Our patient is only 2 years old. To our understanding, such a large bone defect in a small boy patient is rarely reported in literature and hard to treat in clinical practice.…”

Defectos óseos segmentarios infectados en huesos largos: tratamiento con técnica de Masquelet.[Masquelet technique for the treatment of infected segmental long-bone defects]

“…Masquelet tardó 16 años en publicar su técnica, ya que los hallazgos accidentales y los excelentes resultados en su serie de pacientes infectados lo llevaron a profundizar el estudio de los procesos histopatológicos de la membrana, hasta comprender el fundamento de los resultados obtenidos. 5,12 En la actualidad, encontramos referencias bibliográficas justificando su uso en defectos óseos no infectados, 17 reconstrucciones oncológicas [19][20][21] y defectos congénitos. 21,22 La formación de granulomas como respuesta a un cuerpo extraño es una parte esencial de la cicatrización tisular.…”

“…La biomembrana previene la reabsorción del injerto, evita la interposición de tejido fibroso y secreta factores de crecimiento que contribuyen a la consolidación ósea. [15][16][17][18] Este procedimiento se utiliza actualmente en adultos y niños para seudoartrosis infectadas y no infectadas de huesos largos, 17 reconstrucciones oncológicas [19][20][21] o defectos congénitos. 21,22 Los objetivos de este estudio multicéntrico, retrospectivo son mostrar los resultados clínicos y radiográficos obtenidos con esta técnica de reconstrucción en DOS infectados de fémur y tibia, caracterizar los defectos tratados y describir los diferentes aspectos de la técnica quirúrgica.…”

A Novel Multiscale Mathematical Model for Building Bone Substitute Materials for Children

“…Furthermore, these biodegradable materials are mainly made for adult patients with orthopedic issues such as aging-related pathologies and do not provide the specific high toughness required for children bone biomechanics. Thus, reducing failure in children orthopedic issues outcomes is a great challenge in biomaterial sciences [ 4 , 5 , 6 ].…”