This allows restoration of the length and also helps control the infection. Subsequently, 68 weeks later the cement spacer is removed and the space with the biomembrane is packed with autogenous bone grafting harvested using. Implementation of the masquelet technique in complicated septic nonunion of the ulnaa case report 295 a b c fig. The masquelet technique is another effective way to repair extensive bone defects. Masquelet technique for treatment of posttraumatic bone. Knochendefekte mit gelenkbeteiligung, persistierender knocheninfekt oder osteomyelitis, insuffiziente weichteildeckung im bereich. Large defects require more complex alternatives like, bone transport, vascularized bone grafting, allografts or fibular protibia grafting.
The masquelet technique for membrane induction and the. The technique is very demanding and patients cooperation is critical. Pdf masquelet technique for treatment of posttraumatic bone. Intramedullary nail after masquelet bone graft fracture.
Comparative efficacy of the masquelet versus titanium mesh. Masquelet induced membrane technique for the surgical. Pdf masquelet technique, which is the use of a temporary cement. The size of a scaffold is reported to be a critical factor for bone healing. 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. Towards understanding therapeutic failures in masquelet. For many years the masquelet technique has been successfully used in the reconstruction of osseous defects of the long bones. The masquelets induced membrane technique for repairing bone defects has been demonstrated to be a promising treatment strategy. Implementation of the masquelet technique in complicated. Reconstruction of large segmental bone defects in rabbit. Reconstruction of extensive traumatic bone loss in children especially after gunshot injury represents a complex and challenging clinical entity with significant longterm morbidity. Masquelet technique for reconstruction of the ankle. The masquelet technique in the healing of critical sized.
Usually discovered during the first months of life, cpc is characterised by a definitive bone defect in the middle third of the clavicle. Ap a and lateral b radiographs of an open fracture right distal tibia gustilo type iiia at admission. Tibial defect or may be used as free flap for all type of bone defect. They may be due to trauma, bone infection, congenital defects or extensive excision of malignant tumours. Possibility of onestage surgery to reconstruct bone. The patient was followed closely in the clinic and eventually went on to an infection free union shown in figure 3.
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. Jcm free fulltext towards understanding therapeutic. In pediatrics, the masquelet technique is now mainly used in the context of cancer. The bone graft utilized is autologous cancellous pieces or filtered reamerirrigatoraspirator graft, which can be expanded further with osteoconductive, osteoinductive, and osteogenic material. Masquelet conceived and developed an original reconstruction technique for large diaphyseal bone defects, based on the notion of induced membrane 1. Some kind of small or acute fractures can be cured but the risk is greater for large fractures like compound fractures. Masquelet technique the authors 2020 combined with. Masquelets technique for management of long bone defects. Ota video library treatment of a segmental bone defect. The masquelet technique of induced membrane for healing of. Induced membrane formation is accomplished by a bone cement spacer in the. First described by masquelet in 2000, this technique 6 is illustrated by a case study from the bundeswehr central hospital in koblenz.
For the first time, this study aims at correlating imt failures with physiological alterations of the induced membrane im in patients. It is a 2stage procedure for healing of substantial bone defects, with or without the presence of infection. Large bone defects are difficult clinical problems. The healing of critical sized segmental defects is an ongoing clinical problem. The masquelet defect reconstruction is a twostage technique for the treatment of large segmental bone defects. Recurrence of infection requires debridement of the membrane and surrounding soft tissues and reinitiation of the technique return to first stage. Masquelet technique for reconstruction of osseous defects. 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. Pso pseudarthrose osteomyelite chronique masquelet membrane induite. Defects up to 5 cm with adequate soft tissue envelope can often be managed by autologous bone grafting abg. The firststage surgery includes radical debridement of bone and soft tissues, followed by implantation of a polymethylmethacrylate pmma cement spacer at the. There are advantages and disadvantages to these techniques and patients cooperation is. Congenital pseudarthrosis of the clavicle treated by.
The metallic antibiotic nail was retained at this procedure. Masquelet conceived and developed an original reconstruction technique for large diaphyseal bone defects, based on the notion of the induced a pseudomembrane, this. 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. Posttraumatic long bone osteomyelitis ptom is a relatively frequent occurrence in patients with severe open fractures and requires treatment to prevent limbthreatening complications. Innovative strategies for the management of long bone. Eight patients operated between 2011 and 2014 were included. The masquelet technique was first described in 2000 to treat diaphyseal defects up to 25 cm in the tibia. The masquelet technique of induced membranes for healing. Inhibition of dll4notch1 pathway promotes angiogenesis of.
Masquelet technique, which is the use of a temporary cement spacer followed by staged bone grafting, is a recent treatment strategy to manage. Bone generally has the ability to regenerate completely but requires a. Comparing the masquelet technique to other surgical. Management of large bone defects in diaphyseal fractures. Retrospective study based on patient records and radiographs. Themetallicantibiotic nail was retained at this procedure. 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. 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. The principle of the induced membrane technique involves provoking a foreign body reacts by placing a cement spacer in the bone defect. In cases of severe soft tissue injury, the use of a flap can be necessary. This video demonstrates the use of the masquelet technique for a large 18cm femoral defect. The antibiotic spacer was removed at the time of the procedure and the masqueletinduced membrane technique was used to fill the bony defect fig. Pdf masquelet technique for treatment of posttraumatic. Introduction management of the large gap in long bone fractures is a challenging problem after compound injuries.
The masquelet technique is an innovative technique involving the induction of a fibrous tissue membrane around the. In the first stage, the defect is temporarily filled with a polymethyl methacrylate pmma spacer. The masquelet technique in traumatic loss of the talus. There is no single current technique that is reliably successful in the management of large bone defects. This twostaged method for bone reconstruction was first described by masquelet et al in 1986 6. 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. Csh is an outstanding bone substitute due to its easy availability, excellent biocompatibility, biodegradability, and osteoconductivity. Successful bone grafting via masquelet technique around a.
Previous studies have shown that the vessel density of induced. Reconstruction of large diaphyseal defects without free fibular transfer. When is the correct time for the patient to bear full weight especially in. The masquelet technique does offer an alternative and a viable management strategy for large bone defects. Surgical technique and indications of the induced membrane. The induced membrane im technique has been used for more than 30 years. It was initially debrided, stabilized, and shortened with an external fixator, leaving a. Bone defect, of whatever cause, is clinically challenging to treat. The masquelet technique represents a lengthindependent, twostaged reconstruction that involves the induction of a periosteal membrane and use of an antibiotic. The masquelet induced membrane technique with bmp and a.
Masquelet technique for the treatment of bone defects. Masquelet reconstruction for posttraumatic segmental bone. 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. 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. In a first step, a spacer is implanted in the defect site. The inducedmembrane technique, also known as the masquelet technique, has been shown to be generally successful in achieving bony union. Recently, masquelet proposed a procedure combining induced membranes and cancellous autografts. 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. The induced membrane technique for bone defect reconstruction was. There are pertinent clinical questions that clinicians need to ask when applying the technique. Generally asymptomatic, the pseudarthrosis of the clavicle can cause aesthetic issues and functional. We report herein an acute masquelet technique for reconstructing bone defects of open lower limb fractures as the primary treatment in the acute phase. Masquelet technique for treatment of posttraumatic bone defects.
Initially described for bone loss resulting from septic non union of the leg, it has been extended to all long bone. The masquelet technique was first performed in 1986. The masquelet technique is an additional bone reconstruction method with which to sufficiently treat initially infected long bone defects in multiple operations. Masquelet technique for reconstruction of extensive bone. 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. It involves creating a biomembrane using a pmma cement spacer within the defect. The first stage involves thorough bone and soft tissue debridement, insertion of a polymethylmethacrylate cement spacer into the defect, and stabilization of the limb. Introduction bone defects may result from a variety of causes. Masquelet technique for the treatment of a severe acute. The masquelet technique for the treatment of large bone defects is a two. It will therefore be necessary to add a local flap or free flaps to this stage to. The twostage masquelet inducedmembrane technique imt consists of cement spacerdriven membrane induction followed by an autologous cancellous bone implantation in this membrane to promote large bone defect repairs. The ilizarov technique is a slow and painful process and requires a. 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.
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