Reconstruction of large segmental bone defects in rabbit. They may be due to trauma, bone infection, congenital defects or extensive excision of malignant tumours. The antibiotic spacer was removed at the time of the procedure and the masqueletinduced membrane technique was used to fill the bony defect fig. Recurrence of infection requires debridement of the membrane and surrounding soft tissues and reinitiation of the technique return to first stage. Bone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly. Masquelet technique for reconstruction of osseous defects. The masquelet inducedmembrane technique for the treatment of segmental bone defects includes a twostage surgical procedure, and polymethylmethacrylate pmma plays a major role in the treatment. There is no single current technique that is reliably successful in the management of large bone defects. The technique is very demanding and patients cooperation is critical. Ota video library treatment of a segmental bone defect.
Large bone defects are difficult clinical problems. The masquelet technique, an emerging alternative approach first described by alain masquelet, 14, consists of a twostage procedure that allows reconstruction of large segmental bone defects of up to 25 cm 15, 16. In the first stage, the defect is temporarily filled with a polymethyl methacrylate pmma spacer. The purpose of the study was to assess the results compared to other types of bone reconstruction and share our tips and tricks to improve the outcome. Tibial defect or may be used as free flap for all type of bone defect. The patient was followed closely in the clinic and eventually went on to an infection free union shown in figure 3. The masquelet technique is a relatively new innovation involving the induction of a fibrous tissue membrane around the bone defect site taking advantage of the bodys foreign body reaction to the presence of a polymethylmethacrylate pmma spacer. Masquelet technique the authors 2020 combined with. The masquelets induced membrane technique for repairing bone defects has been demonstrated to be a promising treatment strategy. The masquelet technique of induced membranes for healing. Comparing the masquelet technique to other surgical. Congenital pseudarthrosis of the clavicle cpc is a very rare pathology of which over 200 cases have been reported. Innovative strategies for the management of long bone. Masquelet technique for treatment of posttraumatic bone defects.
Subsequently, 68 weeks later the cement spacer is removed and the space with the biomembrane is packed with autogenous bone grafting harvested using. When is the correct time for the patient to bear full weight especially in. The principle of the induced membrane technique involves provoking a foreign body reacts by placing a cement spacer in the bone defect. The firststage surgery includes radical debridement of bone and soft tissues, followed by implantation of a polymethylmethacrylate pmma cement spacer at the. Implementation of the masquelet technique in complicated septic nonunion of the ulnaa case report 295 a b c fig. Masquelet technique, which is the use of a temporary cement spacer followed by staged bone grafting, is a recent treatment strategy to manage a posttraumatic bone defect. Masquelet technique for the treatment of bone defects. The masquelet technique does offer an alternative and a viable management strategy for large bone defects.
Defects up to 5 cm with adequate soft tissue envelope can often be managed by autologous bone grafting abg. Masquelet conceived and developed an original reconstruction technique for large diaphyseal bone defects, based on the notion of the induced a pseudomembrane, this. Large defects require more complex alternatives like, bone transport, vascularized bone grafting, allografts or fibular protibia grafting. Csh is an outstanding bone substitute due to its easy availability, excellent biocompatibility, biodegradability, and osteoconductivity. Pdf masquelet technique for treatment of posttraumatic bone. Generally asymptomatic, the pseudarthrosis of the clavicle can cause aesthetic issues and functional. Previous studies have shown that the vessel density of induced. Towards understanding therapeutic failures in masquelet. Ap a and lateral b radiographs of an open fracture right distal tibia gustilo type iiia at admission. The masquelet induced membrane technique with bmp and a. Masquelet technique for reconstruction of the ankle. Large segmental bone defects can be repaired using the masquelet technique in conjunction with autologous cancellous bone acb. The masquelet defect reconstruction is a twostage technique for the treatment of large segmental bone defects.
Masquelet induced membrane technique for the surgical. Bone generally has the ability to regenerate completely but requires a. The masquelet technique is an additional bone reconstruction method with which to sufficiently treat initially infected long bone defects in multiple operations. It was initially debrided, stabilized, and shortened with an external fixator, leaving a. Pdf masquelet technique, which is the use of a temporary cement. The masquelet technique was first performed in 1986. Masquelet technique, which is the use of a temporary cement spacer followed by staged bone grafting, is a recent treatment strategy to manage.
The masquelet technique in traumatic loss of the talus. The masquelet technique in the healing of critical sized. Bone defect, of whatever cause, is clinically challenging to treat. Masquelet technique for reconstruction of extensive bone. In pediatrics, the masquelet technique is now mainly used in the context of cancer. Eight patients operated between 2011 and 2014 were included. For the first time, this study aims at correlating imt failures with physiological alterations of the induced membrane im in patients. Some kind of small or acute fractures can be cured but the risk is greater for large fractures like compound fractures. In cases of severe soft tissue injury, the use of a flap can be necessary.
Jcm free fulltext towards understanding therapeutic. Posttraumatic long bone osteomyelitis ptom is a relatively frequent occurrence in patients with severe open fractures and requires treatment to prevent limbthreatening complications. Knochendefekte mit gelenkbeteiligung, persistierender knocheninfekt oder osteomyelitis, insuffiziente weichteildeckung im bereich. The induced membrane im technique has been used for more than 30 years. Described by masquelet et al1 massive segmental long bone defects 2 step process thorough debridement and placement of a pmma spacer, fixation careful removal of the spacer keeping the induced membrane intact and grafting morcellized cancellous auto and allo. Introduction bone defects may result from a variety of causes. The reconstruction of bone defects of open lower leg fractures is challenging, and there is no established treatment strategy to date, especially in the acute phase. The masquelet technique was first described in 2000 to treat diaphyseal defects up to 25 cm in the tibia. First described by masquelet in 2000, this technique 6 is illustrated by a case study from the bundeswehr central hospital in koblenz. Successful bone grafting via masquelet technique around a.
The size of a scaffold is reported to be a critical factor for bone healing. Management of large bone defects in diaphyseal fractures. The masquelet technique represents a lengthindependent, twostaged reconstruction that involves the induction of a periosteal membrane and use of an antibiotic. The twostage masquelet inducedmembrane technique imt consists of cement spacerdriven membrane induction followed by an autologous cancellous bone implantation in this membrane to promote large bone defect repairs. The masquelet technique of induced membrane for healing of.
Implementation of the masquelet technique in complicated. Congenital pseudarthrosis of the clavicle treated by. Reconstruction of extensive traumatic bone loss in children especially after gunshot injury represents a complex and challenging clinical entity with significant longterm morbidity. The first stage involves thorough bone and soft tissue debridement, insertion of a polymethylmethacrylate cement spacer into the defect, and stabilization of the limb. The masquelet technique is another effective way to repair extensive bone defects. Masquelet technique for the treatment of a severe acute. The masquelet technique for membrane induction and the.
It is a 2stage procedure for healing of substantial bone defects, with or without the presence of infection. For many years the masquelet technique has been successfully used in the reconstruction of osseous defects of the long bones. Induced membrane formation is accomplished by a bone cement spacer in the. It involves creating a biomembrane using a pmma cement spacer within the defect. Intramedullary nail after masquelet bone graft fracture. In a first step, a spacer is implanted in the defect site. This allows restoration of the length and also helps control the infection. This video demonstrates the use of the masquelet technique for a large 18cm femoral defect. The healing of critical sized segmental defects is an ongoing clinical problem.
There are advantages and disadvantages to these techniques and patients cooperation is. The induced membrane technique for bone defect reconstruction was. Themetallicantibiotic nail was retained at this procedure. A novel technique called as masquelets technique of induced membrane formation, is used to bridge a gap of more than 5 cm using bone cement as a spacer in first stage and autologous cancellous bone graft to fill the gap in second stage. Masquelets technique for management of long bone defects.
Pso pseudarthrose osteomyelite chronique masquelet membrane induite. Recently, masquelet proposed a procedure combining induced membranes and cancellous autografts. The inducedmembrane technique, also known as the masquelet technique, has been shown to be generally successful in achieving bony union. This paper describes a series of 9 patients treated with this technique of staged bone grafting following placement of an antibiotic spacer to successfully manage osseous long bone defects. The bone graft utilized is autologous cancellous pieces or filtered reamerirrigatoraspirator graft, which can be expanded further with osteoconductive, osteoinductive, and osteogenic material.
Inhibition of dll4notch1 pathway promotes angiogenesis of. The masquelet technique for the treatment of large bone defects is a two. There are pertinent clinical questions that clinicians need to ask when applying the technique. Retrospective study based on patient records and radiographs. This technique has been utilized successfully for diaphyseal bone loss up to 25 cm in length, without the need for a vascularized free bone graft transfer 4, 6. Introduction management of the large gap in long bone fractures is a challenging problem after compound injuries. The metallic antibiotic nail was retained at this procedure. The ilizarov technique is a slow and painful process and requires a. Masquelet reconstruction for posttraumatic segmental bone. We report herein an acute masquelet technique for reconstructing bone defects of open lower limb fractures as the primary treatment in the acute phase.
Pdf masquelet technique for treatment of posttraumatic. Masquelet technique for management of large bone defects. Masquelet procedure in eight patients, and compare the results to other techniques of bone defect management described in the literature. Possibility of onestage surgery to reconstruct bone. Reconstruction of large diaphyseal defects without free fibular transfer. Masquelet technique for treatment of posttraumatic bone. The masquelet technique is an innovative technique involving the induction of a fibrous tissue membrane around the. Masquelet conceived and developed an original reconstruction technique for large diaphyseal bone defects, based on the notion of induced membrane 1. This paper describes a series of 9 patients treated with this technique of staged bone grafting following placement of an antibiotic spacer to successfully manage osseous long. It will therefore be necessary to add a local flap or free flaps to this stage to. The masquelet technique is a relatively new innovation involving the induction of a fibrous tissue membrane around the bone defect site taking advantage of the bodys foreign body reaction to the presence of a polymethylmethacrylate. Initially described for bone loss resulting from septic non union of the leg, it has been extended to all long bone.
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