scholarly journals Modified Masquelet Technique Using Allogeneic Graft for a Gustilo-Anderson Type III-A Open Fracture of the Femur with an 8 cm Bone Defect

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hichem Issaoui ◽  
Mohammed Reda Fekhaoui ◽  
Moheddin Jamous ◽  
Alain-Charles Masquelet
Keyword(s):  
Bone Graft ◽  
Bone Defect ◽  
Bony Union ◽  
Induced Membrane ◽  
Masquelet Technique ◽  
Membrane Technique ◽  
Defect Area ◽  
Induced Membrane Technique ◽  
Large Bone

The induced membrane technique was initially described by Masquelet et al. in 1986 as a treatment for tibia nonunion; then, it became one of the established methods in the management of bone defects. Several changes have been made to this technique and have been used in different contexts and different methodologies. We present the case of a 16-year-old girl admitted to our department for a polytrauma after a motorcycle accident. She presented a Gustilo III-A open fracture of the right femoral shaft with a large bone defect of 8 centimeters that we treated with a modified Masquelet technique. In the first stage, an Open Reduction and Internal Fixation of the fracture was made using a 4,5 mm Dynamic Compression Plate and a PMMA cement was inserted at the bone defect area. The second stage was done after 11 weeks, and the defect area was filled exclusively with bone allograft from a bone bank. Complete bony union was seen at 60 weeks of follow-up. After the removal of the implants by another surgeon, the patient presented an atraumatic fracture of the neoformed bone that we treated with intramedullary femoral nailing associated with a local autograft using reaming debris. A complete bony union was achieved after 12 weeks with a complete range of motion of the hip and knee. The stability given to the fracture is essential because it influences the quality of the induced membrane and Masquelet has recommended high initial fixation rigidity to promote incorporation of the graft. It is recommended to delay the second stage of this technique after 8 weeks, especially in femoral reconstruction, to optimize the quality of the induced membrane. Several studies used a modified induced membrane technique to recreate a traumatic large bone defect, and all of them used an autologous bone graft alone or an enriched bone graft. In this case, the use of allograft exclusively seems to be as successful as an autologous or enriched bone graft. Now, with the advent of bone banks, it is possible to get an unlimited amount of allograft, so additional research and large studies are necessary before giving recommendations.

scholarly journals Total Flavonoids of Rhizoma Drynariae Promotes Differentiation of Osteoblasts and Growth of Bone Graft in Induced Membrane Partly by Activating Wnt/β-Catenin Signaling Pathway

2021 ◽  
Vol 12 ◽  
Author(s):  
Shuyuan Li ◽  
Hongliang Zhou ◽  
Cheng Hu ◽  
Jiabao Yang ◽  
Jinfei Ye ◽  
...  
Keyword(s):  
Western Blot ◽  
Bone Graft ◽  
Signaling Pathway ◽  
Bone Defect ◽  
Dose Group ◽  
Total Flavonoids ◽  
Induced Membrane ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
Rhizoma Drynariae

Total flavonoids of Rhizoma drynariae (TFRD), a Chinese medicine, is widely used in the treatment of fracture, bone defect, osteoporosis and other orthopedic diseases, and has achieved good effects. Purpose of this trial was to explore efficacy of TFRD on bone graft’s mineralization and osteoblasts’ differentiation in Masquelet induced membrane technique in rats. Forty male Sprague-Dawley rats were randomly divided into high dose group (H-TFRD), middle dose group (M-TFRD), low dose group (L-TFRD) and control group (control). The critical size bone defect model of rats was established with 10 rats in each group. Polymethyl methacrylate (PMMA) spacer was implanted into the defect of right femur in rats. After the formation of the induced membrane, autogenous bone was implanted into the induced membrane. After 12 weeks of bone graft, bone tissues in the area of bone graft were examined by X-ray, Micro-CT, hematoxylin-eosin (HE) and Masson trichrome staining to evaluate the growth of the bone graft. The β-catenin, c-myc, COL1A1, BMP-2 and OPN in bone graft were quantitatively analyzed by Western blot and Immunohistostaining. Osteoblasts were cultured in the medium containing TFRD. Cell Counting Kit-8 (CCK-8) method, Alkaline phosphatase (ALP) and Alizarin Red S (ARS) staining, Western blot, RT-PCR and other methods were used to detect the effects of TFRD on the proliferation of osteoblasts and the regulation of Wnt/β-catenin signaling pathway. In vivo experiments showed that the growth and mineralization of bone graft in TFRD group was better. Moreover, the expression of Wnt/β-catenin and osteogenesis-related proteins in bone tissue of TFRD group was more than that in other groups. In vitro experiments indicated that osteoblasts proliferated faster, activity of ALP was higher, number of mineralized nodules and proteins related to osteogenesis were more in TFRD group. But blocking Wnt/β-catenin signaling pathway could limit these effects. Therefore, TFRD could promote mineralization of bone graft and differentiation of osteoblasts in a dose-dependent manner during growing period of the bone graft of induced membrane technique, which is partly related to the activation of Wnt/β-catenin signaling pathway.

Bone-Graft Resorption Reduced by the Induced Membrane Technique and Factors Affecting Volumetric Changes

2020 ◽  
Vol 102 (14) ◽  
pp. 1269-1278
Author(s):  
Jae-Woo Cho ◽  
William T. Kent ◽  
Chang-Wug Oh ◽  
Beom-Soo Kim ◽  
Won-Tae Cho ◽  
...  
Keyword(s):  
Bone Graft ◽  
Factors Affecting ◽  
Induced Membrane ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
Graft Resorption

Reconstruction of Large Bone Defects Using induced membrane Technique of Masquelet

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Mohammed soliman ◽  
Yousif Khira ◽  
.mohamed Elzoheiry ◽  
ahmad abdelwahab
Keyword(s):  
Bone Defects ◽  
Induced Membrane ◽  
Membrane Technique ◽  
Induced Membrane Technique ◽  
Large Bone ◽  
Large Bone Defects

scholarly journals Induced membrane technique in the treatment of infectious bone defect: A clinical analysis

2019 ◽  
Vol 105 (3) ◽  
pp. 535-539 ◽  
Author(s):  
Jianbing Wang ◽  
Qudong Yin ◽  
Sanjun Gu ◽  
Yongwei Wu ◽  
Yongjun Rui
Keyword(s):  
Bone Defect ◽  
Clinical Analysis ◽  
Induced Membrane ◽  
Membrane Technique ◽  
Induced Membrane Technique

scholarly journals The deleterious relationship of Pseudomonas aeruginosa and Induced Membranes in infected non-union treatment

2021 ◽  
Vol 12 (1) ◽  
pp. 388-391
Author(s):  
Thiyagarajan U ◽  
Senthil Loganathan ◽  
Raghavendar ◽  
Pradeep P
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bone Graft ◽  
Bone Defect ◽  
Bone Defects ◽  
Reconstructive Procedures ◽  
Induced Membrane ◽  
Non Union ◽  
Masquelet Technique ◽  
Slime Layer ◽  
Pseudomonas Infection

The Masquelet technique was originally described for the treatment of an infected non-union with an extensive bone defect where a staged protocol was needed to first eliminate an infection then secondarily bone graft a defect. Though this is a versatile technique, certain limitations/ complications must be recognized. The study was done between 2012 to 2019 at SRIHER university. 19 patients in whom the Masquelet technique has failed is taken into study. 17 male and two females, with a mean age of 31 years (range of 13 yrs. – 51 yrs.) with a mean follow up of 12 months. The 19 patients who presented with Pseudomonas aeruginosa infected non-union of the tibia and femur with bone defects underwent the Masquelet technique. All patients failed to form adequate induced membrane at the non-union site. Infected non-union with a bone defect is difficult to treat. Bone defects of 2cms can be treated by cancellous bone grafting. Defects more than 4-5cms will require specialized reconstructive procedures to prevent amputation. The two common techniques used are Ilizarov technique with bone transport and bone graft into an induced membrane as described by Masquelet. This study shows a high failure rate of the Masquelet technique with Pseudomonas infection. The most difficult issue faced by the surgeon in treating P. aeruginosa is its ability to develop resistance to multiple classes of antibiotics during the course of treating the patient. Masquelet technique is used extensively for the treatment of infective non-union. Pseudomonas secretes a slime layer that may lead to a weak or deficient formation of the induced membrane. And the elution of antibiotics may not be adequate for intramedullary osteomyelitis with pseudomonas growth. This limits the Masquelet technique in the management of infected non-union with pseudomonas infection.

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