Induced membrane technique for clavicle reconstruction in paediatric patients: Report of four cases

Abstract

BackgroundClavicular reconstruction in paediatric patients is a rarely performed procedure that often raises complex technical challenges and produces unreliable outcomes. The induced membrane technique is an innovative two-stage procedure involving cement spacer placement into the defect to induce the development of a membrane, followed by the implantation of a cortical-cancellous bone graft. The primary objective of this study was to assess the medium- and long-term clinical and radiographic outcomes of clavicular reconstruction using the induced membrane technique in children and to highlight the advantages and drawbacks of this technique. The secondary objectives were to evaluate the fixation and the outcomes according to age and to the underlying diagnosis. HypothesisClavicular reconstruction using the induced membrane technique produces good outcomes in paediatric patients. Patients and methodsThe induced membrane technique was used for clavicular reconstruction in 4 children with a mean age of 9.7 years (range, 7.4–12.3 years). The diagnosis was congenital pseudarthrosis of the clavicle in 3 patients and aneurysmal bone cyst in 1 patient. Shoulder pain and mobility were assessed at last follow-up. Radiological bone healing was evaluated using the total radiographic union score (RUS, range, 0–10). Complications and number of procedures per patient were recorded. ResultsMean follow-up was 3.9 years (range, 1–8.4 years). None of the patients had pain or motion range limitation. After 6 months, the clavicle was healed with a RUS of 10 in all patients. The mean number of surgical procedures per patient was 3.75 (range, 3–5). Two patients required revision surgery for distal pin migration and another for a subcutaneous abscess under the pin. DiscussionWhen used for clavicular reconstruction, the induced membrane technique is effective and associated with a low complication rate. The induced membrane technique therefore deserves to be viewed as an alternative to other methods. Level of evidenceIV, retrospective observational study.