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Induced Membrane Technique: The Treatment of Choice for Bone Defect due to Post-traumatic Osteomyelitis.
Abstract
Objective: To determine the radiological and functional outcome of induced membrane technique for the treatment of long bone defect due to post traumatic osteomyelitis.
Methods: This descriptive study was conducted in Unit I Department of Orthopedic Surgery Jinnah Hospital Lahore. The study extended from 16th November 2018 to 15th May 2022.All patients with long bone post traumatic osteomyelitis with bone defects fulfilling the inclusion criteria were treated with induced membrane technique for eradication of infection followed by fixation and bone grafting. Follow up visits were scheduled for assessment of radiological and clinical union of fracture.
Results: A total of 80 patients were included in this study. The mean age was 38.4±12.1 years. Male patients were 73 (91.3%) and females were 7 (8.7%). Right side was involved in 42(52.5%) patients and left side in 38(47.5%) patients. Tibia was involved in 63(78.7%) patients and femur in 17(21.2%) patients. Radiological and clinical union was achieved in 78(97.5%) patients.
Conclusion: Induced membrane technique for long bone defect due to post traumatic Osteomyelitis resulted in higher union rates. This technique is therefore recommended as treatment of choice for long bone defect due to post-traumatic Osteomyelitis.
References
Lipsky BA, Senneville E, Abbas ZG, Aragon-Sanchez J, Diggle M, Embil JM, et al. International Working Group on the Diabetic Foot (IWGDF). Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36 Suppl 1:e3280. doi: 10.1002/dmrr.3280.
Peng J, Ren Y, He W, Li Z, Yang J, Liu Y, et al.Epidemiological, Clinical and Microbiological Characteristics of Patients with Post-Traumatic Osteomyelitis of Limb Fractures in Southwest China: A Hospital-Based Study. J Bone Jt Infect. 2017;2(3):149-153.
Ferguson J, Athanasou N, Diefenbeck M, McNally M. Radiographic and Histological Analysis of a Synthetic Bone Graft Substitute Eluting Gentamicin in the Treatment of Chronic Osteomyelitis. J Bone Jt Infect. 2019;4(2):76-84.
Derakhshandeh H, Aghabaglou F, McCarthy A, Mostafavi A, Wiseman C, Bonick Z, et al .A Wirelessly Controlled Smart Bandage with 3D-Printed Miniaturized Needle Arrays. Adv Funct Mater. 2020;30(13):1905544. doi: 10.1002/adfm.201905544.
Hameed B, Ali Q, Hafeez M, Malik A. Antibacterial and antifungal activity of fruit, seed and root extracts of Citrullus colocynthis plant. Biological and Clinical Sciences Research Journal. 2020;2020(1).Doi. https://doi.org/10.54112/bcsrj.v2020i1.33.
Metsemakers WJ, Morgenstern M, Senneville E, Borens O, Govaert GAM, Onsea J,et al. Fracture-Related Infection (FRI) group. General treatment principles for fracture-related infection: recommendations from an international expert group. Arch Orthop Trauma Surg. 2020 ;140(8):1013-1027.
Masters EA, Ricciardi BF, Bentley KLM, Moriarty TF, Schwarz EM, Muthukrishnan G. Skeletal infections: microbial pathogenesis, immunity and clinical management. Nat Rev Microbiol. 2022 ;20(7):385-400.
Waheed M, Mubeen B, Sarwar M, Hafeez M, Ali Q. Biosynthesis of poly (hydroxyalkanoates). Biological and Clinical Sciences Research Journal. Doi: 2021(1). https://doi.org/10.54112/bcsrj.v2021i1.71.
Govaert GAM, Glaudemans AWJM. Nuclear medicine imaging of posttraumatic osteomyelitis. Eur J Trauma Emerg Surg. 2016;42(4):397-410.
El-Alfy BS, Ali AM. Management of segmental skeletal defects by the induced membrane technique. Indian J Orthop. 2015 ;49(6):643-648.
Wang X, Luo F, Huang K, Xie Z. Induced membrane technique for the treatment of bone defects due to post-traumatic osteomyelitis. Bone Joint Res. 2016;5(3):101-105.
Wang X, Wang Z, Fu J, Huang K, Xie Z. Induced membrane technique for the treatment of chronic hematogenous tibia osteomyelitis. BMC Musculoskelet Disord. 2017 ;18(1):33. doi: 10.1186/s12891-017-1395-6.
Masquelet AC, Fitoussi F, Begue T, Muller GP. Reconstruction des os longs par membrane induite et autogreffe spongieuse [Reconstruction of the long bones by the induced membrane and spongy autograft]. Ann Chir Plast Esthet. 2000 ;45(3):346-353.
O'Malley NT, Kates SL. Advances on the Masquelet technique using a cage and nail construct. Arch Orthop Trauma Surg. 2012 ;132(2):245-248.
Flamans B, Pauchot J, Petite H, Blanchet N, Rochet S, Garbuio P, et al. Pertes de substance osseuse à la main et au poignet traitées en urgence par technique de la membrane induite (technique de Masquelet) [Use of the induced membrane technique for the treatment of bone defects in the hand or wrist, in emergency]. Chir Main. 2010 ;29(5):307-14. French. doi: 10.1016/j.main.2010.06.008.
Pelissier P, Masquelet AC, Bareille R, Pelissier SM, Amedee J. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res. 2004;22(1):73-79.
El-Hadidi TT, Soliman HM, Farouk HA, Radwan MAE. Staged bone grafting for the management of segmental long bone defects caused by trauma or infection using induced-membrane technique. Acta Orthop Belg. 2018 ;84(4):384-396.
Giannoudis PV, Harwood PJ, Tosounidis T, Kanakaris NK. Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes. Injury. 2016 ;47 Suppl 6:S53-S61.
Yoon YC, Kim Y, Song HK, Yoon YH. Efficacy of Staged Surgery in the Treatment of Open Tibial Fractures with Severe Soft Tissue Injury and Bone Defect. Yonsei Med J. 2022;63(10):915-926.
Hsu CA, Chen SH, Chan SY, Yu YH. The Induced Membrane Technique for the Management of Segmental Tibial Defect or Nonunion: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020;2020:5893642. doi: 10.1155/2020/5893642.
