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Preliminary Results of the Induced Membrane Technique for the Reconstruction of Large Bone Defects

Preliminary Results of the Induced Membrane Technique for the Reconstruction of Large Bone Defects

Authors :
Ismat Ghanem
Toni M. Mansour
Source :
Journal of Pediatric Orthopaedics. 37:e67-e74
Publication Year :
2017
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2017.

Abstract

Background During past decades, gradual bone transplant using external fixators and vascularized fibular or rib transplants widely contributed to solve difficult problems related to the reconstruction of large bone defects in children. However, these surgeries are time consuming and require specialized surgical skills, not always available in a general hospital setting, mainly in rural areas. Purpose To report the preliminary results of the more recently described induced membrane technique in a consecutive series of 8 children and to identify some factors related to the procedure's success. Methods Nine consecutive children with bone defects ranging from 5 to 14 cm were included in the study. The age at surgery ranged from 3 to 16 years. There were 3 congenital pseudarthrosis (CP) of the fibula, 1 CP of the tibia, 1 Ewing sarcoma of the tibia, 1 Ewing sarcoma of the ulna, 1 tibial osteosarcoma, 1 fibular osteosarcoma, and 1 chronic diffuse tibial osteomyelitis. The procedure was performed according to the original Masquelet's description in 2 stages. Follow-up ranged from 1 to 7 years. Results The child with tibial osteosarcoma died 3 months after the surgery from complications related to chemotherapy. Among the 8 remaining children, 6 healed uneventfully, and 2 required revision with additional grafting and/or better internal fixation, one with Ewing sarcoma of the tibia and a 13-cm bone defect and the second with CP of the fibula. Both of them had suboptimal internal stabilization. Conclusions The induced membrane technique is a useful, efficient, and simple alternative to highly specialized surgical procedures used for the reconstruction of large bone defects in children. Risk factors for failure include chemotherapy, suboptimal bone fixation, and persistent axial malalignment. Level of evidence Level IV.

Details

ISSN :
02716798
Volume :
37
Database :
OpenAIRE
Journal :
Journal of Pediatric Orthopaedics
Accession number :
edsair.doi.dedup.....618eb6a416b2a37cf4c7fe634a29f940
Full Text :
https://doi.org/10.1097/bpo.0000000000000663