Reconstruction of infected long bone defects: Issues and Challenges.

https://doi.org/10.1016/j.tcr.2022.100723

Staged treatment of a comminuted femoral fracture with Masquelet technique and 3D printed reposition guides

Several modifications of the induced membrane technique (IMT) have been reported, but there is no consensus regarding their results and prognosis. Moreover, most studies have focused on tibial defects; no meta‐analysis of the treatment of femoral defects using the IMT has been reported. This systematic review and meta‐analysis aimed to identify the potential risk factors of post‐procedural complications following the treatment of segmental femoral defects using the IMT. A comprehensive search was performed on the Cochrane Library, EBSCO, EMBASE, Ovid, PubMed, Scopus, and Web of Science databases, using the keywords “femur,” “Masquelet technique,” and “induced membrane technique.” Original articles composed in English, having accessible individual patient data, and reporting more than two cases of bony defect or nonunion of femur or more than five cases of any body part were included. Post‐procedural bone graft infections, final union status, and union time after second‐stage operation were analyzed. Fourteen reports, including 90 patients, were used in this study. External fixation in second‐stage surgery had an odds ratio of 9.267 for post‐procedural bone graft infection (p = 0.047). The odds ratio of post‐procedural bone graft infection and age >65 years for final non‐union status was 51.05 (p = 0.003) and 9.18 (p = 0.042). Shorter union time was related to impregnated antibiotics in the spacer (p = 0.005), transplanting all‐autologous grafts (p = 0.042), and the application of intramedullary nails as the second‐stage fixation method (p = 0.050). The IMT appears to be reasonable and reproducible for femoral segmental bone defects. Several preoperative and surgical factors may affect post‐procedural complications and union time.

Induced Membrane Technique for the Management of Segmental Femoral Defects: A Systematic Review and Meta‐Analysis of Individual Participant Data

Abstract Because of its simplicity, reliability, and replicability, the Masquelet induced membrane technique (IMT) has become one of the preferred methods for critical bone defect reconstruction in extremities. Although it is now used worldwide, few studies have been published about IMT in military practice. Bone reconstruction is particularly challenging in this context of care due to extensive soft-tissue injury, early wound infection, and even delayed management in austere conditions. Based on our clinical expertise, recent research, and a literature analysis, this narrative review provides an overview of the IMT application to combat-related bone defects. It presents technical specificities and future developments aiming to optimize IMT outcomes, including for the management of massive multi-tissue defects or bone reconstruction performed in the field with limited resources. 

/pdf/masquelet-technique-in-military-practice-specificities-and-39wnnkas.pdf

Masquelet technique in military practice: specificities and future directions for combat-related bone defect reconstruction

Does the distal nail position impact the rates of misalignment and bone union in distal tibial fractures?

Introduction The aim of this study was to describe union, reoperation and failure rates after using the induced membrane (IM) technique with ≥50% allograft over autograft to treat infected femoral and tibial segmental bone defects (SBD). Materials and methods We retrospectively analyzed patients with femoral and tibial SBD treated in our center between 2012 and 2019 using ≥50% allograft over autograft during the second stage of the Masquelet technique. We analyzed the affected bone, defect size, osteosynthesis technique used, time elapsed between the first and second stage of the technique, graft proportions, union time, reoperations, and non-union rates. Results We included 21 patients (61.90% men) with a median age of 41 (range 18-68) years. The tibia was affected in 61.90% (n:13) and the femur in 38.09% (n:8) of the cases. SBD length was 4.5 (range 3.5-14) cm. The median interval between both stages of the technique was 10 (range 6-28) weeks. The proportion of allograft used was 50 % in 10 patients, 51 to 55% in 5 patients, 56 to 59% in 4 patients, and 60 to 64% in 2. The union rate was 95.23% over a median time of 7 (range 6-12) months. There were 3 (14.28%) reoperations: 2 for relapse of infection and 1 for mechanical instability. There was one failure (4.76%). One patient presented non-union and nail break. The median follow-up after the second stage of the technique was 26 (range 13-54) months. Conclusion The use of the induced membrane technique and a high proportion of allograft (up to 64%) achieved similar union and failure rates than those reported for similar series that relied on lower allograft proportions.

Masquelet technique in post-traumatic infected femoral and tibial segmental bone defects. Union and reoperation rates with high proportions (up to 64%) of allograft in the second stage.

Dynamization has already been described as a secondary intervention for delay unions of tibial shaft fractures treated with intramedullary nailing. Although it’s a common procedure, it is not widely supported in the literature. The purpose of this study was to determine the union rate of nail dynamization in cases of delayed union of diaphyseal tibial fractures, and assess the effect of fracture morphology on union rates. We retrospectively analyzed a series of 199 consecutive tibial shaft fractures. We recorded the dynamization rate, period from nailing to dynamization, nailing to the union, the fracture pattern (according to AO/ASIF and whether it was closed or open), the callus diameter before dynamization (fracture healing index; FHI) and union/failure rates. Out of a total of 199 fractures treated during the study period, 41 (20.6%) were dynamized. After applying inclusion and exclusion criteria, 39 patients with 39 fractures were included in the study. The mean time from nailing to dynamization was 18.4 ± 7.2 weeks. The union rate was 92.3% (n = 36) over a mean time of 14.1 ± 5.6 weeks as from dynamization. The overall failure rate was 6.7% (n = 3). There was no significant association between failure and AO/ASIF classification (p > 0.05) or fracture exposure (X2 = 0.19; p = 0.66). The pre-dynamization FHI of ≥ 1.17 was significantly associated with consolidation (p < 0.05). In cases of delayed union of tibial fractures, dynamization offered a high union rate associated with pre-dynamization FHI, while fracture morphology did not affect the failure rate.

Effectiveness of Nail Dynamization in Delayed Union of Tibial Shaft Fractures: Relationship Between Fracture Morphology, Callus Diameter, and Union Rates

Introducción: Pocos cuestionarios para cuantificar y categorizar las limitaciones funcionales subjetivas y objetivas en la patología de hombro han sido traducidos al español de la Argentina. 
Objetivo: Realizar la estandarización, traducción y adaptación transcultural del Constant-Murley Score al español de la Argentina. 
 Materiales y Métodos: La adaptación cultural se realizó siguiendo las etapas propuestas en la guía de la International Society of Pharmacoeconomic and Outcomes Research que establece las directrices para la traducción y adaptación cultural de medidas reportadas por los pacientes. 
Resultados: La versión traducida al español fue evaluada mediante entrevistas cognitivas en dos etapas. Posteriormente se reformularon preguntas para el mejor entendimiento de los elementos y sus opciones de respuesta y, dentro de cada apartado, se realizaron modificaciones específicas. 
Conclusión: Se logró realizar la traducción y adaptación transcultural del Constant-Murley Score, con lo que se obtuvo una herramienta para aplicar en la población argentina con patologías de hombro. 
 

/pdf/traduccion-y-adaptacion-transcultural-del-constant-murley-1imqx16a.pdf

Traducción y adaptación transcultural del Constant-Murley Score al español de la Argentina

Introducción: El objetivo de este estudio retrospectivo fue evaluar si la reducción abierta con cerclaje de alambre afectó la consolidación, la tasa de complicaciones y de reoperaciones en pacientes con fracturas subtrocantéricas de cadera, tratadas con clavos cefalomedulares. 
Materiales y Métodos: Se evaluó a todos los pacientes operados consecutivamente entre enero de 2010 y diciembre de 2017. Se comparó a los tratados con cerclaje (Grupo A) o sin cerclaje (Grupo B) de alambre en términos de tipo de fractura, estancia hospitalaria, tiempo quirúrgico, necesidad de transfusiones, calidad de la reducción, consolidación y complicaciones (infección, seudoartrosis, reoperaciones). 
Resultados: Se incluyó a 58 pacientes. El grupo A estaba conformado por 20 pacientes y el grupo B, por 38. El tipo de fractura más frecuente fue 3A (p = 0,0004). La estancia hospitalaria fue similar (9.0 vs. 10.6 días; p = 0,81), el tiempo quirúrgico y la necesidad de transfusiones fue mayor en el grupo A (p <0,0001 y p = 0,58, respectivamente). La tasa de consolidación fue similar en ambos grupos (90 vs. 92,1%, respectivamente; p = 0,09). Los desejes se observaron solo en el grupo tratado sin lazadas (5-13,5%; p = 0,01). Las tasas de complicaciones (15 vs. 18,4%) y de reoperaciones (15 vs. 15,8%) fueron similares (p = 0,99). 
Conclusiones: El uso de lazadas de alambre en fracturas subtrocantéricas de cadera tratadas con clavos cefalomedulares generó un aumento significativo del tiempo quirúrgico, y disminuyó significativamente la incidencia de desejes. La incidencia de reoperaciones fue menor, aunque no significativamente.

/pdf/cerclaje-con-alambre-en-fracturas-subtrocantericas-de-cadera-2k1auo1c.pdf

Tamara Dainotto

Papers

Masquelet technique in post-traumatic infected femoral and tibial segmental bone defects. Union and reoperation rates with high proportions (up to 64%) of allograft in the second stage.

Effectiveness of Nail Dynamization in Delayed Union of Tibial Shaft Fractures: Relationship Between Fracture Morphology, Callus Diameter, and Union Rates

Traducción y adaptación transcultural del Constant-Murley Score al español de la Argentina

Cerclaje con alambre en fracturas subtrocantéricas de cadera. Análisis de beneficios y complicaciones