Abstract
Purpose To identify the predicting factors for union and infection after applying the induced membrane technique (IMT) for segmental tibial defects. Methods A systematic review was carried out following the PRISMA guidelines. All databases were searched for articles published between January 2000 and February 2018 using the keywords “Masquelet technique” and “induced membrane technique.” Studies in English reporting more than 5 cases with accessible individual patient data were included. A meta-analysis was performed. Odds ratios (OR) with 95% confidence intervals were calculated. Results After reviewing, 11/243 studies (115 patients) were finally selected. The mean age of the patients was 43.6 years (range: 18-84 years), and the mean length of the tibial defect was 5.5 cm (range: 0-20 cm). The multivariate logistic regression analysis revealed that the risk factors of postoperative infection after IMT were infected nonunion (p = 0.0160) and defect length ≥ 7 cm (p = 0.0291). Patients with postoperative infection after IMT had a lower union rate (p = 0.0003). Additionally, the use of an antibiotic polymethyl methacrylate cement spacer reduced the need for surgical revision (p = 0.0127). Multiple logistic regression indicated no direct association between the union rate and length of the bone defect. Conclusions IMT is a reliable and reproducible treatment for segmental tibial defects. However, initial infected nonunion and defect length greater than 7 cm are risk factors for post-IMT infection, and post-IMT infection was statistically related to nonunion.
Highlights
Posttraumatic segmental bone defects and recalcitrant nonunions mostly affect the tibia [1, 2]; their management is challenging for surgeons
It is generally accepted that bone defects shorter than 6 cm can be treated by nonvascularized autologous bone grafting while the defects longer than 6 cm are managed by other techniques [3, 4] such as distraction osteogenesis [5], free vascularized fibular bone graft [6], allograft [7], titanium cages [8], or even amputation in extreme cases
There are several reconstruction techniques for these cases that ensure a better quality of life, including direct autologous bone grafting, distraction osteogenesis [5], and free vascularized fibular bone grafting [6]
Summary
Posttraumatic segmental bone defects and recalcitrant nonunions mostly affect the tibia [1, 2]; their management is challenging for surgeons. It is generally accepted that bone defects shorter than 6 cm can be treated by nonvascularized autologous bone grafting while the defects longer than 6 cm are managed by other techniques [3, 4] such as distraction osteogenesis [5], free vascularized fibular bone graft [6], allograft [7], titanium cages [8], or even amputation in extreme cases. Among these treatments, distraction osteogenesis and free vascularized bone grafts are among the most common procedures because of their satisfactory results. Vascularized fibular bone grafts require microsurgical skills, which are technically demanding and not available at every hospital
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