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