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Management of traumatic tibial diaphyseal bone defect by "induced-membrane technique".

Abstract：

BACKGROUND:Gap nonunion of long bones is a challenging problem, due to the limitation of conventional reconstructive techniques more so if associated with infection and soft tissue defect. Treatment options such as autograft with non-vascularized fibula and cancellous bone graft, vascularized bone graft, and bone transportation are highly demanding on the part of surgeons and hospital setups and have many drawbacks. This study aims to analyze the outcome of patients with wide diaphyseal bone gap treated with induced-membrane technique (Masquelet technique). MATERIALS AND METHODS:This study included 9 patients (7 males and 2 females), all with tibial bone-gap. Eight of the 9 patients were infected and in 3 patients there was associated large soft tissue defect requiring flap cover. This technique is two-stage procedure. Stage I surgery included debridement, fracture stabilization, application of spacer between bone ends, and soft tissue reconstruction. Stage II surgery included removal of spacer with preservation of induced membrane formed at spacer surface and filling the bone-gap with morselized iliac crest bone-graft within the membrane sleeve. Average bone-gap of 5.2 cm was treated. The spacer was always found to be encapsulated by a thick glistening membrane which did not collapse after its removal. All patients were followed up for an average period of 21.5 months. RESULTS:Serial Radiographs showed regular uptake of autograft and thus consolidation within themselves in the region of bone gap and also with host bone. Bone-union was documented in all patients and all patients are walking full weight-bearing without support. CONCLUSIONS:The study highlights that the technique provide effective and practical management for difficult gap nonunion. It does not require specialized equipment, investigations, and surgery. Thus, it provides a reasonable alternative to the developing infrastructures and is a reliable and reproducible technique.

journal_name

Indian J Orthop

journal_title

Indian journal of orthopaedics

authors

Gupta G,Ahmad S,Mohd Zahid,Khan AH,Sherwani MK,Khan AQ

doi

10.4103/0019-5413.181780

subject

Has Abstract

pub_date

2016-05-01 00:00:00

pages

290-6

issue

eissn

0019-5413

issn

1998-3727

pii

IJOrtho-50-290

journal_volume

pub_type

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Management of traumatic tibial diaphyseal bone defect by "induced-membrane technique".