Staged bone grafting for the management of segmental long bone defects caused by trauma or infection using induced-membrane technique

Abstract

Treatment of segmental bone defects resulting from trauma or infection is extremely difficult. Bone segment transport with distraction osteogenesis and vascularized fibula transfer are the commonest used methods of treatment. Bone transport has problems with docking site. Vascularized fibula is technically demanding and hypertrophy occurs late. Induced membrane (Masquelet) technique is a relatively recent and simple treatment option consisting of two stages. A biological membrane is formed around cement spacer which is inserted in bone defect. In
the second stage, the spacer is carefully removed and the membrane filled with autologous cancellous bone graft.

From May 2013 to October 2015, we treated 20 patients with post-traumatic and post-infectious bone defect using Masquelet technique. There were 17 males and 3 females, with an average age of 38 years (range 12-64). The etiology of defect was open fractures in 6 cases (30%), infected non union in 11 cases (55%) and aseptic atrophic nonunion in 3 cases (15%). The mean size of bone defect after debridement was 7.2 cm. Soft tissue defect was present in 3 cases which was reconstructed. In the first stage involves thorough debridement, stabilization of the bone (either external or internal) and insertion of antibiotic cement spacer. 2nd stage was done after 4 to 8 weeks with insertion of morselized cancellous bone graft harvested from iliac bone, then tight
closure done. 17 cases (85%) united, 2 cases (10%) of graft resorption and 1 case (5%) of infected graft. The time to union ranged from 4 to 11 months after 2nd stage with mean 7.4 months.

In conclusion, induced membrane (Masquelet) technique is a safe, simple and reliable method for treating segmental bone defect. The major complications of this technique include infection   and graft resorption.