Masquelet's induced membrane technique for reconstruction of large extra-articular intercalary bone defect

Abstract

Background: Intercalary bone defects are challenging for both surgeon and patient. The Masquelet's induced membrane technique saves bone consolidation time is less technically demanding than other techniques and achieves good results in the reconstruction of large extra-articular intercalary bone defects. Patients and Methods: This prospective study reviewed 60 patients treated with the induced membrane technique. Patients with femoral or tibial extra-articular intercalary bone defects ≥5 cm long, occurring either posttraumatically or after debridement of infected bone, were included in the study. Patients with bone defects <5 cm long were excluded from the study. The male-to-female ratio was 17:3. Patient age ranged from 10 to 50 years. Recorded outcomes included union, infection, residual deformity, soft-tissue healing, persistent pain, return to previous occupation, permanent joint contracture, and patient satisfaction. Results: Mean follow-up was 3.1 years (range, 2.2–4 years). Mean intercalary bone defect measured 7.5 cm (range, 5–13 cm) in length. Forty-five of 60 patients had open fractures. Thirty-nine underwent Ilizarov fixation, 12 with locked plates, and nine with a limb reconstruction system. The mean interval between the first and second stages was 56 days (range, 42–84 days). Bony union was achieved in 51 patients (85%). Twelve patients experienced relapsed infection during treatment, three because of flap failure, and nine because of inadequate debridement. Three were treated with repeat debridement and free vascularized flap after gastrocnemius flap, six underwent bone transport, and three required amputation. Conclusion: The Masquelet's induced membrane technique was highly effective in achieving the union of large femoral intercalary bone defects, with mixed results in the tibia.