Masquelet technique : A promising technique for infected & gap non-unions

Vol 35 | Issue 1 | Jan-April 2020 | page: 26-28 | Digvijay Agarwal, Rajesh Maheshwari

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Authors: Digvijay Agarwal [1], Rajesh Maheshwari [1]

¹Department of Orthopaedic Surgery, SRHU, Jollygrant  Dehradun, Uttarakhand, India.

Address of Correspondence:
Dr. Ziaul Hoda Shaan,
SRHU, Jollygrant, Dehradun, Uttarakhand,India.
E-mail: digidigi5@yahoo.co.in


Introduction: Management of bone defects due to trauma, bone infection, congenital defects or extensive excision of malignant tumors is very challenging. The approach is multidisciplinary and patients should be prepared for a long course of multiple surgeries and possible complications.The small size gaps management is easier with cancellous bone graft or non-vascularized bone-grafting. Larger defects require other options like; vascularized bone-grafts, bonetransport, non-vascularized grafts, allografts and fibular grafting. These techniques are associatedwith their morbidity, complications and require expertise. Masquelet technique is a relative new technique used in the management of large bone defects.
Material & Method
We performed masquelet induced membrane technique in 10 patients Out of ten patients two involving infected nonunion tibia were treated with bone grafting and plaster cast application as they had smaller bone defect of less than 5cm size, two patients with infected gap nonunion humerus were treated with intra-medullary interlocking nail and bone grafting. Rest all were treated with bone grafting and locking plate fixation.The average size of the bone defect after debridement was 13 cm (4– 25 cm).
Conclusion- Membrane induced technique given by Masquelet is very effective two staged procedure to treat long bone defects seen in infected non-union, gap non-union seen in fractures with bone loss. No expertise is required

Keywords: Bone graft, Bone gap, Cement spacer, Membrane


References

1)Gerber A, Gogolewski A. Reconstruction of large segmental defects in the sheep tibia using polylactide membrane. A clinical and radiographic report. Injury, Int. J. Care Injured. 2002;33 S-B-43-57.
2)Nauth A, McKee MD, Einhorn TA, et al. Managing bone defects.
J Orthop Trauma. 2011;25:462–466.
3)Pelissier Ph., Masquelet A. C., Bareille R., et al. Induced membrane secrete growth factors including vascular and osteoconductive factors and could stimulate bone regeneration. Journal of Orthopaedic Research 2004; 22: 73 – 79.
4)Thonse R, Conway J. Antibiotic cement-coated interlocking nail for the treatment of infected nonunions and segmental bone defects. J Orthop Trauma. 2007;21:258–268.
5)Masquelet AC, Obert L. Induced membrane technique for bone defects in hand and wrist. Chir Main. 2010;29 (suppl1):S221-S224.
6)Woon CY, Chong KW, Wong MK. Induced membranes e 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.
7)Pelissier P, Masquelet AC, Bareille R, Mathoulin-Pelissier S, Amedee J. Induced membranes secretes growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res. 2004; 22:73-79.
8) Spinella-Jaegle S, Roman S, Faucheu C, et al. Opposite effects of BMP-2 and TGF beta-1 on osteoblast differentiation. Bone.1998; 29:323-330.


How to Cite this Article: Agarwal D, Maheshwari R | Masquelet technique : A promising technique for infected & gap non-unions | Journal of Bone and Joint Diseases Jan-April 2020; 35(1): 26-28..

 



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