Induced Membrane (Masquelet) Technique for Treatment of Long Bone Defects

Abstract
Background: Reconstruction of large segmental bone defects following trauma, tumor resection or debridement of an infected segment, is a complicated problem with significant long-term morbidity, both for anatomical and functional results. Treatment of large bone defects represents a great challenge, as bone regeneration is required in large quantity and may be beyond the potential for self-healing. A two-stage technique uses induced biologic membranes with delayed placement of bone graft to manage this clinical challenge. In the first stage, a polymethyl methacrylate spacer is placed in the defect to produce a bioactive membrane. In the second, cancellous autograft is placed within this membrane and, via elution of several growth factors, the membrane appears to prevent graft resorption and promote revascularization and consolidation of new bone. Excellent clinical results have been reported, with successful reconstruction of segmental bone defects >20cm.
Objective: The aim of the present study is to evaluate the Masquelet technique in the treatment of post-traumatic seg-mental bone defects.
Study Design and Setting: A prospective study.
Patients and Methods: This study included twenty patients having segmental bone defects ranging from 4 to 19cm (av-erage 6.35cm) either post-traumatic or following resection of the infected segment in cases of infected un-united fractures. All cases were treated using induced membrane (Masquelet) technique. The mean follow-up period was 11 months.
Results: Union was achieved in 17 patients (85%). Satis-factory end results were achieved in fifteen patients (75%) according to the system modified by El-Rosasy from Paley et al., Reconstruction failure with non-union occurred in three patients. Infective complications occurred in two patients (10%). Both of them suffered from non-union.
Conclusion: The technique of delayed bone grafting after initial placement of a cement spacer provides a reasonable alternative for the challenging problem of significant bone loss in extremity reconstruction.