Use of Masquelet technique in treatment of septic and atrophic fracture nonunion

Raven, Tim Friedrich; Moghaddam, Arash; Ermisch, C.; Westhauser, Fabian; Brückner, Thomas; Schmidmaier, Gerhard

doi:10.1016/j.injury.2019.06.018

Cited by 56 publications

(42 citation statements)

References 82 publications

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“…A review of the current literature shows that the Masquelet technique is effective for the treatment of large bone defects. For example, Raven et al were able to achieve good healing results in patients with atrophic and/or infected pseudarthrosis [33]. The use of this technique also provided acceptable levels of healing in the military setting for patients with open tibial fractures; in the latter case, prior elimination of infections was a major challenge [34].…”

Section: Discussionmentioning

confidence: 99%

From two stages to one: acceleration of the induced membrane (Masquelet) technique using human acellular dermis for the treatment of non-infectious large bone defects

Verboket

Leiblein

Janko

et al. 2020

Eur J Trauma Emerg Surg

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Introduction The induced membrane technique for the treatment of large bone defects is a two-step procedure. In the first operation, a foreign body membrane is induced around a spacer, then, in the second step, several weeks or months later, the spacer is removed and the Membrane pocket is filled with autologous bone material. Induction of a functional biological membrane might be avoided by initially using a biological membrane. In this study, the effect of a human acellular dermis (hADM, Epiflex, DIZG gGmbH) was evaluated for the treatment of a large (5 mm), plate-stabilised femoral bone defect. Material and MethodsIn an established rat model, hADM was compared to the two-stage induced membrane technique and a bone defect without membrane cover. Syngeneous spongiosa from donor animals was used for defect filling in all groups. The group size in each case was n = 5, the induction time of the membrane was 3-4 weeks and the healing time after filling of the defect was 8 weeks. Results The ultimate loads were increased to levels comparable with native bone in both membrane groups (hADM: 63.2% ± 29.6% of the reference bone, p < 0.05 vs. no membrane, induced membrane: 52.1% ± 25.8% of the reference bone, p < 0.05 vs. no membrane) and were significantly higher than the control group without membrane (21.5%). The membrane groups were radiologically and histologically almost completely bridged by new bone formation, in contrast to the control Group where no closed osseous bridging could be observed. Conclusion The use of the human acellular dermis leads to equivalent healing results in comparison to the two-stage induced membrane technique. This could lead to a shortened therapy duration of large bone defects.

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Section: Discussionmentioning

confidence: 99%

From two stages to one: acceleration of the induced membrane (Masquelet) technique using human acellular dermis for the treatment of non-infectious large bone defects

Verboket

Leiblein

Janko

et al. 2020

Eur J Trauma Emerg Surg

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“…Even though median success rates are high, there is a significant amount of variation and the outcome for the failed union after Masquelet treatment is often amputation. Infection is the most commonly reported complication in retrospective case series 24,25 and the nonunion rate is slightly higher in infected bones 26 . Emerging data suggest that the ability to form an IM varies among patients and that this correlates with the successful graft‐to‐bone union after the second surgery 7,25 .…”

Section: Discussionmentioning

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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“…However, the infected and nonviable tissues are sometimes difficult to differentiate from healthy tissue in a single debridement, and if the polymethylmethacrylate (PMMA) spacer is inserted at the same time, it can lead to recurrence of infection and failure of the induced membrane technique, as failure to eradicate infection has been reported at rates of 3-20.7% [3,5]. Moreover, it is unnecessary to aggressively eliminate vascularized sclerotic tissue because the poorly vascularized parts can increase stability and decrease bone graft volume.…”

Section: Introductionmentioning

confidence: 99%

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

Zhang

Zhu

et al. 2020

Med Sci Monit

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Departmental sources Background: Infected bone defects are therapeutic challenges. Although the induced membrane technique has been used for this problem, there is a 3% to 20.7% failure to eradicate infection, and there have been few reports about its use in tuberculous infection. We present our three-stage induced membrane technique (TSIMT) for treating infected bone defects of the lower extremity. Material/Methods: Forty-one adult patients with infected bone defects of the lower extremities treated by TSIMT were included in a retrospective case-series study between January 2013 and June 2018. The clinical, imaging and laboratory assessment outcomes were analyzed. Results: In the first stage, 3 patients had ankle tuberculous bone defects and 17 patients underwent 2-4 debridements. In the second stage, the average bone defect was 6.0 cm; 1 patient needed an anterolateral thigh flap to cover the wound. In the third stage, 10 patients underwent autograft mixed allograft, and 18 cases used internal fixation. The mean follow-up period was 23.3 months. All patients achieved bone union and clinical eradication of infection. Changes in Lower Extremity Functional Scale (LEFS) scores after 1 year of TSIMT and bone union time are associated with advanced age, longer duration of infected bone defects, active smoking, and external fixation (p<0.05), but are not dependent on bone defect size, debridement times, type of bone graft, or spacer-placing time (p>0.05). Conclusions: TSIMT is effective in treating infected bone defects of the lower extremities. Advanced age, longer duration of infected bone defects, active smoking, and external fixation adversely affect bone union and recovery of infected extremities in a limited time span.

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Use of Masquelet technique in treatment of septic and atrophic fracture nonunion

Cited by 56 publications

References 82 publications

From two stages to one: acceleration of the induced membrane (Masquelet) technique using human acellular dermis for the treatment of non-infectious large bone defects

From two stages to one: acceleration of the induced membrane (Masquelet) technique using human acellular dermis for the treatment of non-infectious large bone defects

Evaluation of global gene expression in regenerate tissues during Masquelet treatment

Management of Infected Bone Defects of the Lower Extremities by Three-Stage Induced Membrane Technique

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