Matheus L Azi1, Armando Augusto de A Teixeira, Ricardo B Cotias, Alexander Joeris, Mauricio Kfuri. 1. *Manoel Victorino Hospital, Secretary of Health for the State of Bahia, Bahia, Brazil;†AO Clinical Investigation and Documentation, Dübendorf, Switzerland; and‡Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, Ribeirao Preto Medical School, University of Sao Paulo (FMRP-USP), São Paulo, Brazil.
Abstract
OBJECTIVE: To evaluate the union rate of posttraumatic bone defects treated with the induced membrane technique. DESIGN: Single-center retrospective case series. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Thirty-three patients who sustained 34 posttraumatic bone defects (19 tibia, 15 femur). INTERVENTION: Staged management using the induced membrane technique described by Masquelet. After extensive debridement at the fracture site, a polymethylmethacrylate (PMMA) spacer was inserted into the resulting void. After soft tissue recovery, the spacer was removed, and the void, now enveloped by an induced membrane, was filled with an autologous iliac crest bone graft. MAIN OUTCOME MEASURES: Bone union rate, time to achieve bone union, length of hospital stay, number of surgeries, infection resolution, range of motion, musculoskeletal tumor society system functional score, and limb shortening. RESULTS: The mean defect size was 6.7 cm, and infection was present in 23 (68%) of the bone defects. Bone union was evident in 91% of cases (31/34). The average time to union was 8.5 months. In 7 of 23 (30%) of infected cases, the infection recurred, and in 3 of them, the graft was resorbed, resulting in treatment failure. CONCLUSION: The induced membrane technique was effective for managing posttraumatic bone defects. A recurrence of infection was associated with treatment failure. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVE: To evaluate the union rate of posttraumatic bone defects treated with the induced membrane technique. DESIGN: Single-center retrospective case series. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Thirty-three patients who sustained 34 posttraumatic bone defects (19 tibia, 15 femur). INTERVENTION: Staged management using the induced membrane technique described by Masquelet. After extensive debridement at the fracture site, a polymethylmethacrylate (PMMA) spacer was inserted into the resulting void. After soft tissue recovery, the spacer was removed, and the void, now enveloped by an induced membrane, was filled with an autologous iliac crest bone graft. MAIN OUTCOME MEASURES: Bone union rate, time to achieve bone union, length of hospital stay, number of surgeries, infection resolution, range of motion, musculoskeletal tumor society system functional score, and limb shortening. RESULTS: The mean defect size was 6.7 cm, and infection was present in 23 (68%) of the bone defects. Bone union was evident in 91% of cases (31/34). The average time to union was 8.5 months. In 7 of 23 (30%) of infected cases, the infection recurred, and in 3 of them, the graft was resorbed, resulting in treatment failure. CONCLUSION: The induced membrane technique was effective for managing posttraumatic bone defects. A recurrence of infection was associated with treatment failure. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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