Membrane Induced Osteogenesis in the Management of Posttraumatic Bone Defects

Azi, Matheus Lemos; Teixeira, Armando Augusto de Almeida; Cotias, Ricardo Britto; Joeris, Alexander; Kfuri, Maurício

doi:10.1097/bot.0000000000000614

Cited by 48 publications

(20 citation statements)

References 28 publications

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“…The IM is carefully opened, the spacer is removed, and the membrane is filled with bone graft and repaired such that it encases the graft material. Over 4 to 12 months, the graft consolidates and becomes functionally integrated with the patient's skeleton 4,5 …”

Section: Introductionmentioning

confidence: 99%

Evaluation of global gene expression in regenerate tissues during Masquelet treatment

Gohel

Senos

Goldstein

et al. 2020

Journal Orthopaedic Research

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The Masquelet induced‐membrane (IM) technique is indicated for large segmental bone defects. Attributes of the IM and local milieu that contribute to graft‐to‐bone union are unknown. Using a rat model, we compared global gene expression profiles in critically sized femoral osteotomies managed using a cement spacer as per Masquelet to those left empty. At the end of the experiment, IM and bone adjacent to the spacer were collected from the Masquelet side. Nonunion tissue in the defect and bone next to the empty defect were collected from the contralateral side. Tissues were subjected to RNA isolation, sequencing, and differential expression analysis. Cell type enrichment analysis suggested the IM and the bone next to the polymethylmethacrylate (PMMA) spacer were comparatively enriched for osteoblastic genes. The nonunion environment was comparatively enriched for innate and adaptive immune cell markers, but only macrophages were evident in the Masquelet context. iPathwayGuide was utilized to identify cell signaling pathways and protein interaction networks enriched in the Masquelet environment. For IM vs nonunion false‐discovery rate correction of P values rendered overall pathway differences nonsignificant, and so only protein interaction networks are presented. For the bone comparison, substantial enrichment of pathways and networks known to contribute to osteogenic mechanisms was revealed. Our results suggest that the PMMA spacer affects the cut bone ends that are in contact with it and at the same time induces the foreign body reaction and formation of the IM. B cells in the empty defect suggest a chronic inflammatory response to a large segmental osteotomy.

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Section: Introductionmentioning

confidence: 99%

Evaluation of global gene expression in regenerate tissues during Masquelet treatment

Gohel

Senos

Goldstein

et al. 2020

Journal Orthopaedic Research

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“…In our study, 85.7% (48/56) of the cases acquired bone union during the nal follow up. Compared with Azi's study [11], he acquired higher bone union rate (91%) with this technique. This could be explained by all study cases were large segmental defects.…”

Section: Discussionmentioning

confidence: 57%

Augmented plate causes bone resorption in reconstruction of large segmental femur defects with induced membrane technique

Shen

Yin²,

Cao

et al. 2020

Preprint

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Purposes: Large segmental femur bone defect is a serious clinical problem. Limited study have been reported to optimize the fixation during the second stage of induced membrane technique. We would like to report our new findings in two different fixation method with this technique. Methods: We retrospectively analyzed 56 cases with large segmental femur defects and treated with induced membrane technique from January 2013 to December 2017. Patients were separated into two groups according to different fixation method during the second stage and followed at least 2 years. Bacteria culture, treatment outcome, and complication were collected and analysed. Results: Patients with an average age of 41.8 years old had an average of 2.6 surgical history. Bone defects were 8.93 cm in average ( 4-16.8 cm). Though 20 complications were noticed in this series, 85.7% (48/56) of the cases acquired bone union during their final follow up. However, 57.6%(15/26) of the cases observed obvious bone resorption near the plate in augmented plate group. And this resulted to lower bone union rate was calculated when compared with intramedullary nail group (P = 0.019). Insufficient bone grafting material is another main reason resulted nonunion and verified in 5 cases. Conclusions: Augmented plate will resulted bone resorption and leads to nonunion in induced membrane technique. The plate should be fixated outside the membrane if necessary. Insufficient bone grafting material when grafting is a easily neglectful problem, and proper measures should be taken with cautious.

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“…The results of this procedure were assessed in a study of 33 patients with a total of 34 bone defects 5 . The mean age at the time of treatment was 33 years, and the mean defect size was 6.7 cm.…”

Section: Resultsmentioning

confidence: 99%

“…8-C) after introduction of the spacer into the bone defect. • Graft volume may be enlarged with allograft or biomaterials (demineralized bone matrix or tricalcium phosphate) and enriched with growth factors (bone morphogenetic protein or platelet-rich concentrate) [3][4][5]15 .…”

Section: Contraindicationsmentioning

confidence: 99%

Induced-Membrane Technique in the Management of Posttraumatic Bone Defects

Azi

Teixeira

Cotias

et al. 2019

JBJS Essential Surgical Techniques

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Background: Critical-size bone defects are defined as bone defects where spontaneous regeneration is not expected without treatment 1. The characteristics of bone defects (etiology, location, size, presence of infection, and softtissue conditions) vary greatly and, to be effective, the treatment method should address this variability. The induced-membrane technique, or Masquelet technique, is a method for treating critical-size bone defects 2,3 of various sizes and anatomic locations. It has been used to treat infected and noninfected bone defects and may be performed with a variety of fixation methods 2,3. Description: The induced-membrane technique is a 2-stage procedure. The first stage consists of debridement followed by insertion of a polymethylmethacrylate (PMMA) spacer in the bone defect. The presence of the PMMA leads to a foreign-body reaction with the development of a thick pseudosynovial membrane that is extremely vascularized and rich in growth factors. The filling of the bone defect with the cement spacer prevents fibrous tissue invasion and allows the development of an optimal vascularized gap for bone-grafting. After 6 to 8 weeks, the membrane around the spacer is carefully opened for the removal of the spacer, which is then replaced by bone graft 2,3 , which can be expanded with allograft or biomaterials. Alternatives: Alternatives include vascularized or nonvascularized autologous bone graft, allograft, bone transport methods, titanium cages, megaprostheses, shortening, and amputation. Rationale: Posttraumatic bone defects frequently are associated with soft-tissue injury and infection that impair the local vascularization and the healing potential. The highly vascularized induced membrane may play a role in restoring the local regenerative capacity. Numerous studies have demonstrated its successful use in the treatment of posttraumatic bone defects in the hand, forearm, humerus, femur, tibia, and foot. The induced-membrane technique is especially advantageous in the treatment of infected bone defects because the presence of the spacer helps in the treatment of the infection by reducing dead space, acting as a local antibiotic carrier, and promoting some degree of bone stability 3-5 .

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Membrane Induced Osteogenesis in the Management of Posttraumatic Bone Defects

Abstract: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 48 publications

References 28 publications

Evaluation of global gene expression in regenerate tissues during Masquelet treatment

Evaluation of global gene expression in regenerate tissues during Masquelet treatment

Augmented plate causes bone resorption in reconstruction of large segmental femur defects with induced membrane technique

Induced-Membrane Technique in the Management of Posttraumatic Bone Defects

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