BACKGROUND The induced-membrane technique was initially described by Masquelet as an effective treatment for large bone defects,especially those caused by infection.Here,we report a case of chronic osteomyelitis of th...BACKGROUND The induced-membrane technique was initially described by Masquelet as an effective treatment for large bone defects,especially those caused by infection.Here,we report a case of chronic osteomyelitis of the radius associated with a 9 cm bone defect,which was filled with a large allogeneic cortical bone graft from a bone bank.Complete bony union was achieved after 14 months of follow-up.Previous studies have used autogenous bone as the primary bone source for the Masquelet technique;in our case,the exclusive use of allografts is as successful as the use of autologous bone grafts.With the advent of bone banks,it is possible to obtain an unlimited amount of allograft,and the Masquelet technique may be further improved based on this new way of bone grafting.CASE SUMMARY In this study,we reported a case of repair of a long bone defect in a 40-year-old male patient,which was characterized by the utilization of allograft cortical bone combined with the Masquelet technique for the treatment of the patient's long bone defect in the forearm.The patient's results of functional recovery of the forearm were surprising,which further deepens the scope of application of Masquelet technique and helps to strengthen the efficacy of Masquelet technique in the treatment of long bones indeed.CONCLUSION Allograft cortical bone combined with the Masquelet technique provides a new method of treatment to large bone defect.展开更多
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 us...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.展开更多
Abstract： Long bone septic non-union by MRSA （methicillin-resistant Staphylococcus aureus） is always a challenge for the orthopaedic society. Traditional treatment options include distraction osteogenesis methods a...Abstract： Long bone septic non-union by MRSA （methicillin-resistant Staphylococcus aureus） is always a challenge for the orthopaedic society. Traditional treatment options include distraction osteogenesis methods and vascularised bone grafting. These techniques require a high level of expertise and are frequently involved with a variety of side effects or complications. We present a rare case of ulnar fracture complicated by MRSA infection that led to septic non-union. We treated the septic non union with the technique of induced membrane formation （Masquelet technique）. A 33 year old male presented to the outpatient clinic, 2 months after internal fixation of a Gustillo I fracture of the left forearm. There was pus discharge from the operative wound and specimen culture was positive for MRSA. Initially the patient received conservative treatment with antibiotics for a period of one month. However, the patient returned with the same clinical presentation. The patient was then treated with hardware removal of the ulna and debridement of the septic non-union. The formed 5 cm bone defect was filled with cement spacer and the ulnar bone was fixed with external fixation. Eight weeks later, the spacer was removed and the bone gap was filled with autologous cancellous bone graft from iliac crest. Five months after grafting, the patient was reviewed. No clinical or functional problems were noted and osseous consolidation of the ulnar bone was confirmed in plain x-rays. The Masquelet technique is a promising alternative treatment for the management of infected long bone non-unions of the upper extremity.展开更多
The Masquelet technique,also known as the induced membrane technique,is a surgical technique for repairing large bone defects based on the use of a membrane generated by a foreign body reaction for bone grafting.This ...The Masquelet technique,also known as the induced membrane technique,is a surgical technique for repairing large bone defects based on the use of a membrane generated by a foreign body reaction for bone grafting.This technique is not only simple to perform,with few complications and quick recovery,but also has excellent clinical results.To better understand the mechanisms by which this technique promotes bone defect repair and the factors that require special attention in practice,we examined and summarized the relevant research advances in this technique by searching,reading,and analysing the literature.Literature show that the Masquelet technique may promote the repair of bone defects through the physical septum and molecular barrier,vascular network,enrichment of mesenchymal stem cells,and high expression of bone-related growth factors,and the repair process is affected by the properties of spacers,the timing of bone graft,mechanical environment,intramembrane filling materials,artificial membrane,and pharmaceutical/biological agents/physical stimulation.展开更多
Masquelet technique is one of the modalities for the treatment of long bone defect.Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and ope...Masquelet technique is one of the modalities for the treatment of long bone defect.Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and open growth plate.We reported a case of 13-year-old male who presented with gap non-union of middle third of tibia.We applied a modified Masquelet technique by using only the cortical fibular graft instead of cancellous bone to fill the space surrounded by induced membrane.Fibula was used as a nonvascularized strut graft and matched stick graft to achieve complete union.We concluded that nonvascularized fibula grafting is an easy and effective option to fill the bone defect in children in the second stage of Masquelet technique.展开更多
Objective: To systematically evaluate the clinical efficacy and safety of Masquelet technology and Llizarov group technology in the treatment of infectious bone defects by meta-analysis. Methods: The computer searched...Objective: To systematically evaluate the clinical efficacy and safety of Masquelet technology and Llizarov group technology in the treatment of infectious bone defects by meta-analysis. Methods: The computer searched China Knowledge Network (CNKI), Wanfang, VIP, Chinese Biomedical Literature Database (CBM), Pubmed, Medline, Cochrane Llibrary databases. The retrieval time was from the time of the establishment of the database to January 2020. According to the inclusion and exclusion criteria, randomized controlled trials on the treatment of infectious bone defects using Masquelet technology and Llizarov technology were collected, and the retrieved literature was independently screened, evaluated, and data extracted by two researchers, and then RevMan5.3 software was used so for meta-analysis. Results: A total of 10 RCT documents were included, with a total of 496 patients, including 242 in the Masquelet group and 254 in the Llizarov group. The results of the meta-analysis showed that: in terms of bone defect healing time, total weight bearing time, treatment cost, and complication rate, the Masquelet group was significantly different from the Llizarov group, and the Masquelet group was better than the Llizarov group (P <0.05);In terms of knee joint Lowa score and SF-36 score, Masquelet group has significant differences compared with Llizarov group, Llizarov group is better than Masquelet group (P <0.05);in excellent rate, number of operations, ankle Lowa score, infection control rate In terms of excellent rate of affected limb function, there was no significant difference between Masquelet group and Llizarov group (P> 0.05). Conclusion:Compared with Llizarov technology, Masquelet technology has obvious advantages in the treatment of infectious bone defects in terms of bone defect healing time, total weight-bearing time, treatment cost, and complication rate. In terms of scoring, it has advantages over Masquelet technology, but in terms of excellent treatment rate, number of operations, and ankle lowa score. In terms of infection control rate and excellent function of affected limbs, there was no significant difference between Masquelet technology and Llizarov technology,However, due to the low quality of the included studies and the small sample size, the exact efficacy still needs to be confirmed by higher quality RCT studies.展开更多
文摘BACKGROUND The induced-membrane technique was initially described by Masquelet as an effective treatment for large bone defects,especially those caused by infection.Here,we report a case of chronic osteomyelitis of the radius associated with a 9 cm bone defect,which was filled with a large allogeneic cortical bone graft from a bone bank.Complete bony union was achieved after 14 months of follow-up.Previous studies have used autogenous bone as the primary bone source for the Masquelet technique;in our case,the exclusive use of allografts is as successful as the use of autologous bone grafts.With the advent of bone banks,it is possible to obtain an unlimited amount of allograft,and the Masquelet technique may be further improved based on this new way of bone grafting.CASE SUMMARY In this study,we reported a case of repair of a long bone defect in a 40-year-old male patient,which was characterized by the utilization of allograft cortical bone combined with the Masquelet technique for the treatment of the patient's long bone defect in the forearm.The patient's results of functional recovery of the forearm were surprising,which further deepens the scope of application of Masquelet technique and helps to strengthen the efficacy of Masquelet technique in the treatment of long bones indeed.CONCLUSION Allograft cortical bone combined with the Masquelet technique provides a new method of treatment to large bone defect.
文摘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.
文摘Abstract： Long bone septic non-union by MRSA （methicillin-resistant Staphylococcus aureus） is always a challenge for the orthopaedic society. Traditional treatment options include distraction osteogenesis methods and vascularised bone grafting. These techniques require a high level of expertise and are frequently involved with a variety of side effects or complications. We present a rare case of ulnar fracture complicated by MRSA infection that led to septic non-union. We treated the septic non union with the technique of induced membrane formation （Masquelet technique）. A 33 year old male presented to the outpatient clinic, 2 months after internal fixation of a Gustillo I fracture of the left forearm. There was pus discharge from the operative wound and specimen culture was positive for MRSA. Initially the patient received conservative treatment with antibiotics for a period of one month. However, the patient returned with the same clinical presentation. The patient was then treated with hardware removal of the ulna and debridement of the septic non-union. The formed 5 cm bone defect was filled with cement spacer and the ulnar bone was fixed with external fixation. Eight weeks later, the spacer was removed and the bone gap was filled with autologous cancellous bone graft from iliac crest. Five months after grafting, the patient was reviewed. No clinical or functional problems were noted and osseous consolidation of the ulnar bone was confirmed in plain x-rays. The Masquelet technique is a promising alternative treatment for the management of infected long bone non-unions of the upper extremity.
基金supported by the Shanghai Sailing Program(21YF1458900).
文摘The Masquelet technique,also known as the induced membrane technique,is a surgical technique for repairing large bone defects based on the use of a membrane generated by a foreign body reaction for bone grafting.This technique is not only simple to perform,with few complications and quick recovery,but also has excellent clinical results.To better understand the mechanisms by which this technique promotes bone defect repair and the factors that require special attention in practice,we examined and summarized the relevant research advances in this technique by searching,reading,and analysing the literature.Literature show that the Masquelet technique may promote the repair of bone defects through the physical septum and molecular barrier,vascular network,enrichment of mesenchymal stem cells,and high expression of bone-related growth factors,and the repair process is affected by the properties of spacers,the timing of bone graft,mechanical environment,intramembrane filling materials,artificial membrane,and pharmaceutical/biological agents/physical stimulation.
文摘Masquelet technique is one of the modalities for the treatment of long bone defect.Using cancellous bone graft to fill the bone defect is always a concern in children due to the small size of their iliac crest and open growth plate.We reported a case of 13-year-old male who presented with gap non-union of middle third of tibia.We applied a modified Masquelet technique by using only the cortical fibular graft instead of cancellous bone to fill the space surrounded by induced membrane.Fibula was used as a nonvascularized strut graft and matched stick graft to achieve complete union.We concluded that nonvascularized fibula grafting is an easy and effective option to fill the bone defect in children in the second stage of Masquelet technique.
基金The Science and Technology Project of Henan Province (182102310487)
文摘Objective: To systematically evaluate the clinical efficacy and safety of Masquelet technology and Llizarov group technology in the treatment of infectious bone defects by meta-analysis. Methods: The computer searched China Knowledge Network (CNKI), Wanfang, VIP, Chinese Biomedical Literature Database (CBM), Pubmed, Medline, Cochrane Llibrary databases. The retrieval time was from the time of the establishment of the database to January 2020. According to the inclusion and exclusion criteria, randomized controlled trials on the treatment of infectious bone defects using Masquelet technology and Llizarov technology were collected, and the retrieved literature was independently screened, evaluated, and data extracted by two researchers, and then RevMan5.3 software was used so for meta-analysis. Results: A total of 10 RCT documents were included, with a total of 496 patients, including 242 in the Masquelet group and 254 in the Llizarov group. The results of the meta-analysis showed that: in terms of bone defect healing time, total weight bearing time, treatment cost, and complication rate, the Masquelet group was significantly different from the Llizarov group, and the Masquelet group was better than the Llizarov group (P <0.05);In terms of knee joint Lowa score and SF-36 score, Masquelet group has significant differences compared with Llizarov group, Llizarov group is better than Masquelet group (P <0.05);in excellent rate, number of operations, ankle Lowa score, infection control rate In terms of excellent rate of affected limb function, there was no significant difference between Masquelet group and Llizarov group (P> 0.05). Conclusion:Compared with Llizarov technology, Masquelet technology has obvious advantages in the treatment of infectious bone defects in terms of bone defect healing time, total weight-bearing time, treatment cost, and complication rate. In terms of scoring, it has advantages over Masquelet technology, but in terms of excellent treatment rate, number of operations, and ankle lowa score. In terms of infection control rate and excellent function of affected limbs, there was no significant difference between Masquelet technology and Llizarov technology,However, due to the low quality of the included studies and the small sample size, the exact efficacy still needs to be confirmed by higher quality RCT studies.
