Masquelet technique for the treatment of infected segmental long-bone defects
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Published:
Feb 20, 2019
Keywords:
Segemental bone defect, infected bone defect, femur, tibia, Masquelet technique
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Abstract
Introduction: Infected segmental bone defects are challenging conditions, with complex treatment. Masquelet technique represents an alternative for these cases. The aim of this retrospective, multicenter study was to show clinical and radiological outcomes with the use of this reconstruction technique in infected segmental bone defects of femur and tibia, to characterize the defects treated and to describe different aspects of surgical technique.Methods: We analyzed 24 patients (14 men and 10 women; average age 36.16 years [range 18-67]) treated with Masquelet technique between 2011 and 2016. Average follow-up was 16.5 months (range 12-27) from the second surgical stage. Affected bone, defect length (cm), consolidation time and infectious process control were analyzed.Results: Length of treated bone defect was on average 5.7 cm (range 3-12), it was higher than 4 cm in 50% of the cases. The largest segmental bone defect measured 12 cm at the tibia and 10 cm at the femur. Bone consolidation was achieved in all cases, on average, in 4.5 months. One patient presented a recurrence of the infectious process 12 months after the successful consolidation.Conclusions: Masquelet technique or induced membrane technique offers a reasonable and simple alternative to a highly challenging problem, such as infected segmental bone defects, presenting a consolidation rate greater than 90% even in complex cases.
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Garabano, G., Pesciallo, C., Montero Vinces, A., Gómez, D. J., Bidolegui, F., & Casteulani, A. C. (2019). Masquelet technique for the treatment of infected segmental long-bone defects. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(1), 15-26. https://doi.org/10.15417/issn.1852-7434.2019.84.1.853
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Clinical Research
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References
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Tips-tricks and future directions. Injury 2011;42:591-8. DOI: 10.1016/j.injury.2011.03.036
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6. Mitchell SE, Keating JF, Robinson CM. The treatment of open femoral fractures with bone loss. J Bone Joint Surg Br 2010;92:1678-84. DOI: 10.1302/0301-620X.92B12.25190
7. Gaskill TR, Urbaniak JR, Aldridge JM. Free vascularized fibular transfer for femoral head osteonecrosis: donor and graft site morbidity. J Bone Joint Surg Am 2009;91:861-7. DOI: 10.2106/JBJS.H.01105
8. Myeroff C, Archdeancon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg Am 2011;93:222-7. DOI: 10.2106/JBJS.J.01513
9. Khan SN, Cammisa FP, Jr, Sandhu HS, Diwan AD, Girardi FP, Lane JM. The biology of bone grafts. J Am Acad Orthop Surg 2003;26:923-4. DOI: 10.5435/00124635-200501000-00010
10. Cattaneo R, Catagni M, Johnson EE. The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 1992;280:143-52. DOI: 10.1097/00003086-199207000-00017
11. Pelissier P, Casoli V, Demiri E, Martin D, Baudet J. Soleus-fibula free transfer in lower limb reconstruction. Plast Reconstr Surg 2000;105:567-73. DOI:10.1097/00006534-200002000-00014
12. Masquelet AC, Fitoussi F, Begue T, Muller GP. [Reconstruction of the long bones by the induced membrane and spongy autograft]. Ann Chir Plast Esthet 2000;45:346-53.
13. Micev AJ, Kalainov DM, Soneru AP. Masquelet technique for treatment of segmental bone loss in the upper extremity. J Hand Surg Am 2015;40:593-8. DOI: 10.1016/j.jhsa.2014.12.007
14. Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 2012;98:97-102. DOI: 10.1016/j.otsr.2011.11.001
15. Pelissier P, Masquelet AC, Bareille R, Mathoulin Pelissier S, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 2004;22:73-9. DOI: 10.1016/S0736-0266(03)00165-7
16. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 2010;41:27-37. DOI: 10.1016/j.ocl.2009.07.011
17. Stafford PR, Norris BL. Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: A review of 25 cases. Injury 2010;41:S72-7. DOI: 10.1016/S0020-1383(10)70014-0
18. Bosemark P, Perdikouri C, Pelkonen M, Isaksson H, Tägil M. The Masquelet induced membrane technique with BMP and a synthetic scaffold can heal a rat femoral critical size defect. J Orthop Res 2015;33:488-95. DOI: 10.1002/jor.22815
19. Biau DJ, Pannier S, Masquelet AC, Glorion C. Case report: Reconstruction of a 16-cm diaphyseal defect after ewing’s resection in a child. Clin Orthop Relat Res 2009;467:572-7. DOI: 10.1007/s11999-008-0605-9
20. Fitoussi F, Ilharreborde B. Is the induced-membrane technique successful for limb reconstruction after resecting large bone tumors in children? Clin Orthop Relat Res 2015;473(6):2067-75. DOI: 10.1007/s11999-015-4164-6
21. Amouyel T, Deroussen F, Plancq M-C, Collet L-M, Gouron R. Successful treatment of humeral giant aneurysmal bone cyst: value of the induced membrane reconstruction technique. J Shoulder Elb Surg 2014;23:212-6. DOI: 10.1016/j.jse.2014.05.028
22. Gouron R, Deroussen F, Plancq MC, Collet LM. Bone defect reconstruction in children using the induced membrane technique: A series of 14 cases. Orthop Traumatol Surg Res 2013;99:837-43. DOI: 10.1016/j.otsr.2013.05.005
23. Aho OM, Lehenkari P, Ristiniemi J, Lehtonen S, Risteli J, Leskelä HV. The mechanism of action of induced membranes in bone repair. J Bone Joint Surg Am 2013;95:597-604. DOI: 10.2106/JBJS.L.00310
24. Ren L, Kang Y, Browne C, Bishop J, Yang Y. Fabrication, vascularization and osteogenic properties of a novel synthetic biomimetic induced membrane for the treatment of large bone defects. Bone 2014;64:173-82. DOI: 10.1016/j.bone.2014.04.011
25. Viateau V, Guillemin G, Yang YC, Bensaïd W, Reviron T, Oudina K, et al. A technique for creating criticalsize defects in the metatarsus of sheep for use in investigation of healing of long-bone defects. Am J Vet Res 2004;65:1653-7. DOI: 10.2460/ajvr.2004.65.1653
26. Wong TM, Lau TW, Li X, Fang C, Yeung K, Leung F. Masquelet technique for treatment of posttraumatic bone defects. Sci World J 2014;2014:1-5. DOI: 10.1155/2014/710302. eCollection 2014
27. Woon CY-L, Chong K-W, Wong M-K. Induced membranes—A staged technique of bone-grafting for segmental bone loss. A report of two cases and a literature review. J Bone Joint Surg Am 2010;92:196-201. DOI: 10.2106/JBJS.I.00273
28. Joseph TN, Chen AL, Di Cesare PE, Cesare PE Di, Lindskog DM, Baumgaertner MR. Use of antibioticimpregnated cement in total joint arthroplasty unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg 2003;11:38-47. DOI: 10.5435/00124635-200301000-00006
29. Jaeblon T. Polymethylmethacrylate: properties and contemporary uses in orthopaedics. J Am Acad Orthop Surg
2010;18(5):297-305. DOI: 10.5435/00124635-201005000-00006
30. Kuehn K-D, Ege W, Gopp U. Acrylic bone cements: mechanical and physical properties. Orthop Clin North Am 2005;36:29-39. DOI: 10.1016/j.ocl.2004.06.011
31. Hsieh P-H, Shih C-H, Chang Y-H, Lee MS, Shih H-N, Yang W-E. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am 2004;86(9):1989-97. https://insights.ovid.com/pubmed?pmid=15342762
32. Masquelet AC, Obert L. La technique de la membrane induite pour les pertes de substance osseuse de la main et du poignet. Chir Main 2010;29:221-4. DOI: 10.1016/j.main.2010.10.007
33. Viateau V, Guillemin G, Calando Y, Logeart D, Oudina K, Sedel L, et al. Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: An ovine model. Vet Surg 2006;35:445-52. DOI: 10.1111/j.1532-950X.2006.00173.x
34. Viateau V, Guillemin G, Bousson V, Oudina K, Hannouche D, Sedel L, et al. Long-bone critical-size defects treated with tissue-engineered grafts: A study on sheep. J Orthop Res 2007;25(6):741-9. DOI: 10.1002/jor.20352
35. Donegan DJ, Scolaro J, Matuszewski PE, Mehta S. Staged bone grafting following placement of an antibiotic spacer block for the management of segmental long bone defects. Orthopedics 2011;19104:730-5. DOI: 10.3928/01477447-20110922-16
36. McCall TA, Brokaw DS, Jelen BA, Scheid DK, Scharfenberger AV, Maar DC, et al. Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series. Orthop Clin North Am 2010;41(1):63-73. DOI: 10.1016/j.ocl.2009.08.002
37. Apard T, Bigorre N, Cronier P, Duteille F, Bizot P, Massin P. Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res 2010;96(5):549-53. DOI: 10.1016/j.otsr.2010.02.010
2. DeCoster TA, Gehlert RJ, Mikola EA, Pirela-Cruz MA. Management of posttraumatic segmental bone defects. J Am Acad Orthop Surg 2004;12:28-38. https://insights.ovid.com/pubmed?pmid=14753795
3. Obremskey WT, Molina CS, Collinge C, Tornetta P, Sagi C, Schmidt A, et al. Current practice in the management of segmental bone defects among orthopaedic trauma surgeons. J Orthop Trauma 2013;28:203-7. DOI: 10.1097/BOT.0000000000000034
4. Giannoudis PV, Faour O, Goff T, Kanakaris N, Dimitriou R. Masquelet technique for the treatment of bone defects:
Tips-tricks and future directions. Injury 2011;42:591-8. DOI: 10.1016/j.injury.2011.03.036
5. Taylor BC, French BG, Fowler TT, Russell J, Poka A. Induced membrane technique for reconstruction to manage bone loss. J Am Acad Orthop Surg 2012;20:142-50. DOI: 10.5435/JAAOS-20-03 142
6. Mitchell SE, Keating JF, Robinson CM. The treatment of open femoral fractures with bone loss. J Bone Joint Surg Br 2010;92:1678-84. DOI: 10.1302/0301-620X.92B12.25190
7. Gaskill TR, Urbaniak JR, Aldridge JM. Free vascularized fibular transfer for femoral head osteonecrosis: donor and graft site morbidity. J Bone Joint Surg Am 2009;91:861-7. DOI: 10.2106/JBJS.H.01105
8. Myeroff C, Archdeancon M. Autogenous bone graft: donor sites and techniques. J Bone Joint Surg Am 2011;93:222-7. DOI: 10.2106/JBJS.J.01513
9. Khan SN, Cammisa FP, Jr, Sandhu HS, Diwan AD, Girardi FP, Lane JM. The biology of bone grafts. J Am Acad Orthop Surg 2003;26:923-4. DOI: 10.5435/00124635-200501000-00010
10. Cattaneo R, Catagni M, Johnson EE. The treatment of infected nonunions and segmental defects of the tibia by the methods of Ilizarov. Clin Orthop Relat Res 1992;280:143-52. DOI: 10.1097/00003086-199207000-00017
11. Pelissier P, Casoli V, Demiri E, Martin D, Baudet J. Soleus-fibula free transfer in lower limb reconstruction. Plast Reconstr Surg 2000;105:567-73. DOI:10.1097/00006534-200002000-00014
12. Masquelet AC, Fitoussi F, Begue T, Muller GP. [Reconstruction of the long bones by the induced membrane and spongy autograft]. Ann Chir Plast Esthet 2000;45:346-53.
13. Micev AJ, Kalainov DM, Soneru AP. Masquelet technique for treatment of segmental bone loss in the upper extremity. J Hand Surg Am 2015;40:593-8. DOI: 10.1016/j.jhsa.2014.12.007
14. Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res 2012;98:97-102. DOI: 10.1016/j.otsr.2011.11.001
15. Pelissier P, Masquelet AC, Bareille R, Mathoulin Pelissier S, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res 2004;22:73-9. DOI: 10.1016/S0736-0266(03)00165-7
16. Masquelet AC, Begue T. The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 2010;41:27-37. DOI: 10.1016/j.ocl.2009.07.011
17. Stafford PR, Norris BL. Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: A review of 25 cases. Injury 2010;41:S72-7. DOI: 10.1016/S0020-1383(10)70014-0
18. Bosemark P, Perdikouri C, Pelkonen M, Isaksson H, Tägil M. The Masquelet induced membrane technique with BMP and a synthetic scaffold can heal a rat femoral critical size defect. J Orthop Res 2015;33:488-95. DOI: 10.1002/jor.22815
19. Biau DJ, Pannier S, Masquelet AC, Glorion C. Case report: Reconstruction of a 16-cm diaphyseal defect after ewing’s resection in a child. Clin Orthop Relat Res 2009;467:572-7. DOI: 10.1007/s11999-008-0605-9
20. Fitoussi F, Ilharreborde B. Is the induced-membrane technique successful for limb reconstruction after resecting large bone tumors in children? Clin Orthop Relat Res 2015;473(6):2067-75. DOI: 10.1007/s11999-015-4164-6
21. Amouyel T, Deroussen F, Plancq M-C, Collet L-M, Gouron R. Successful treatment of humeral giant aneurysmal bone cyst: value of the induced membrane reconstruction technique. J Shoulder Elb Surg 2014;23:212-6. DOI: 10.1016/j.jse.2014.05.028
22. Gouron R, Deroussen F, Plancq MC, Collet LM. Bone defect reconstruction in children using the induced membrane technique: A series of 14 cases. Orthop Traumatol Surg Res 2013;99:837-43. DOI: 10.1016/j.otsr.2013.05.005
23. Aho OM, Lehenkari P, Ristiniemi J, Lehtonen S, Risteli J, Leskelä HV. The mechanism of action of induced membranes in bone repair. J Bone Joint Surg Am 2013;95:597-604. DOI: 10.2106/JBJS.L.00310
24. Ren L, Kang Y, Browne C, Bishop J, Yang Y. Fabrication, vascularization and osteogenic properties of a novel synthetic biomimetic induced membrane for the treatment of large bone defects. Bone 2014;64:173-82. DOI: 10.1016/j.bone.2014.04.011
25. Viateau V, Guillemin G, Yang YC, Bensaïd W, Reviron T, Oudina K, et al. A technique for creating criticalsize defects in the metatarsus of sheep for use in investigation of healing of long-bone defects. Am J Vet Res 2004;65:1653-7. DOI: 10.2460/ajvr.2004.65.1653
26. Wong TM, Lau TW, Li X, Fang C, Yeung K, Leung F. Masquelet technique for treatment of posttraumatic bone defects. Sci World J 2014;2014:1-5. DOI: 10.1155/2014/710302. eCollection 2014
27. Woon CY-L, Chong K-W, Wong M-K. Induced membranes—A staged technique of bone-grafting for segmental bone loss. A report of two cases and a literature review. J Bone Joint Surg Am 2010;92:196-201. DOI: 10.2106/JBJS.I.00273
28. Joseph TN, Chen AL, Di Cesare PE, Cesare PE Di, Lindskog DM, Baumgaertner MR. Use of antibioticimpregnated cement in total joint arthroplasty unstable intertrochanteric hip fractures in the elderly. J Am Acad Orthop Surg 2003;11:38-47. DOI: 10.5435/00124635-200301000-00006
29. Jaeblon T. Polymethylmethacrylate: properties and contemporary uses in orthopaedics. J Am Acad Orthop Surg
2010;18(5):297-305. DOI: 10.5435/00124635-201005000-00006
30. Kuehn K-D, Ege W, Gopp U. Acrylic bone cements: mechanical and physical properties. Orthop Clin North Am 2005;36:29-39. DOI: 10.1016/j.ocl.2004.06.011
31. Hsieh P-H, Shih C-H, Chang Y-H, Lee MS, Shih H-N, Yang W-E. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am 2004;86(9):1989-97. https://insights.ovid.com/pubmed?pmid=15342762
32. Masquelet AC, Obert L. La technique de la membrane induite pour les pertes de substance osseuse de la main et du poignet. Chir Main 2010;29:221-4. DOI: 10.1016/j.main.2010.10.007
33. Viateau V, Guillemin G, Calando Y, Logeart D, Oudina K, Sedel L, et al. Induction of a barrier membrane to facilitate reconstruction of massive segmental diaphyseal bone defects: An ovine model. Vet Surg 2006;35:445-52. DOI: 10.1111/j.1532-950X.2006.00173.x
34. Viateau V, Guillemin G, Bousson V, Oudina K, Hannouche D, Sedel L, et al. Long-bone critical-size defects treated with tissue-engineered grafts: A study on sheep. J Orthop Res 2007;25(6):741-9. DOI: 10.1002/jor.20352
35. Donegan DJ, Scolaro J, Matuszewski PE, Mehta S. Staged bone grafting following placement of an antibiotic spacer block for the management of segmental long bone defects. Orthopedics 2011;19104:730-5. DOI: 10.3928/01477447-20110922-16
36. McCall TA, Brokaw DS, Jelen BA, Scheid DK, Scharfenberger AV, Maar DC, et al. Treatment of large segmental bone defects with reamer-irrigator-aspirator bone graft: technique and case series. Orthop Clin North Am 2010;41(1):63-73. DOI: 10.1016/j.ocl.2009.08.002
37. Apard T, Bigorre N, Cronier P, Duteille F, Bizot P, Massin P. Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. Orthop Traumatol Surg Res 2010;96(5):549-53. DOI: 10.1016/j.otsr.2010.02.010