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Maniglio M, Aguiar F, Roner S, Zaidenberg EE. Assessment, Diagnosis and Management Strategies for Forearm Shaft Non-union: A Contemporary Perspective. J Hand Surg Asian Pac Vol 2024; 29:380-391. [PMID: 39205527 DOI: 10.1142/s2424835524400022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Forearm non-union poses a challenge in orthopaedic surgery due to its intricate anatomy and functional significance. This review provides a comprehensive overview of the assessment, diagnosis and management of forearm non-union. Initial evaluation involves a meticulous history, physical examination and imaging studies to identify factors contributing to non-union, including infection. Surgical approaches are discussed, with emphasis on restoring biomechanical stability and promoting bone healing. Treatment options range from autografts to allografts, with considerations for vascularised bone transfers in complex cases. Decision-making strategies are outlined, considering patient-specific factors and individualised treatment plans. Special considerations for specific types of forearm non-unions are addressed, along with postoperative care protocols to optimise healing and functional outcomes. Overall, this review aims to provide clinicians with a comprehensive understanding of forearm non-union management based on current evidence and clinical practice. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Mauro Maniglio
- Department of Hand Surgery, University Clinic, Balgrist, Zürich, Switzerland
| | - Francisco Aguiar
- Department of Orthopaedics and Traumatology, Clinica Francesa, Mendoza, Argentina
| | - Simon Roner
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ezequiel E Zaidenberg
- Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
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Zhou M, Ma Y, Jia X, Wu Y, Liu J, Wang Y, Wang P, Luo J, Lin F, Wang J, Rui Y. Comparison of free vascularized fibular grafts and the Masquelet technique for the treatment of segmental bone defects with open forearm fractures: a retrospective cohort study. J Orthop Traumatol 2024; 25:44. [PMID: 39342062 PMCID: PMC11438757 DOI: 10.1186/s10195-024-00787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 09/03/2024] [Indexed: 10/01/2024] Open
Abstract
PURPOSE Severe open forearm fractures commonly involve segmental bone defects. Although several methods have been proposed to treat segmental bone defects with such fractures, research comparing the radiological and clinical outcomes of free vascularized fibular grafts (FVFG) and the Masquelet technique (MT) is rare. METHODS Data on 43 patients with open forearm fractures and segmental bone defects treated surgically in our hospital from January 2005 to January 2021 were retrospectively analyzed, and these patients were divided into an FVFG group (18 cases) and an MT group (25 cases). Clinical and radiological evaluations were performed regularly, and the minimum follow-up was 18 months. RESULTS All 43 patients were followed up for 18 to 190 months, with a mean of 46.93 months. The mean follow-up time was significantly longer in the FVFG group than in the MT group (p = 0.000). Bone healing time was 3-16 months, with a mean of 4.67 months. The QuickDASH score at the last follow-up was 0-38.6, with a mean of 17.71, and there was no statistically significant difference between the two groups. Operative time, hospital stay, and intraoperative bleeding for bone defect reconstruction were higher in the FVFG group compared to the MT group (p = 0.000), whereas the number of procedures was lower in the FVFG group than in the MT group (p = 0.035). CONCLUSIONS FVFG and the MT showed satisfactory clinical results for segmental bone defects of the forearm. Compared with FVFG, the MT exhibited a lower operative time, hospital stay, and intraoperative bleeding. LEVEL OF EVIDENCE Level IV. Trial registration This study was registered in the Chinese Clinical Trial Registry (registration no. ChiCTR2300067675; registered 17 January 2023), https://www.chictr.org.cn/showproj.html?proj=189458 .
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Affiliation(s)
- Ming Zhou
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Yunhong Ma
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Xueyuan Jia
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Yongwei Wu
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Jun Liu
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Yapeng Wang
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Peng Wang
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Junhao Luo
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Fang Lin
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China
| | - Jianbing Wang
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China.
| | - Yongjun Rui
- Department of Orthopaedic Surgery, Wuxi Ninth People's Hospital Affiliated to Soochow University, Liangxi Road, No. 999, Binhu District, Wuxi, Jiangsu, China.
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Konstantinou P, Kostretzis L, Ditsiou AZ, Samaras I, Papadopoulos P, Ditsios K. Outcomes of Free Vascularized Fibular Grafts in Treating Massive Forearm Skeletal Defects. J Pers Med 2024; 14:973. [PMID: 39338227 PMCID: PMC11433380 DOI: 10.3390/jpm14090973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 09/09/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION Reconstructing long bone defects in the upper limbs, particularly the radius and ulna, poses significant challenges. These defects, resulting from trauma, tumors, infections, or congenital anomalies, require precise surgical intervention for functional restoration. Traditional non-vascularized autogenous bone grafts have limitations, such as resorption and limited biological activity. To address these challenges, free vascularized fibular grafts (FVFGs) have been developed, offering enhanced recovery by supplying nutrients and structural support, particularly in large defects or compromised vascularity. MATERIALS AND METHODS This retrospective study reviewed patients with significant forearm skeletal defects treated with FVFGs at our institution from January 2008 to January 2019. Included were patients with radius or ulna defects exceeding 8 cm due to trauma, tumor excision, or non-union fractures. Data on demographics, clinical details, surgical techniques, and outcomes-including graft union time, complications, range of motion, and the disabilities of the arm, shoulder and hand (DASH) scores-were analyzed. RESULTS Eight patients, with a mean age of 27.6 years and an average defect length of 9.8 cm, were included. All patients achieved graft union within an average of 4 months, with no tumor recurrence or significant complications. Functional outcomes showed mean forearm pronation of 56.9 degrees, supination of 52.5 degrees, and a mean DASH score of 17.7. CONCLUSIONS FVFG is a safe and effective technique for managing complex forearm bone defects, providing high union rates and good functional outcomes. It should be considered a primary option for large forearm skeletal defects.
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Affiliation(s)
- Panagiotis Konstantinou
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, “G Gennimatas” Hospital, 54124 Thessaloniki, Greece; (L.K.); (I.S.); (P.P.); (K.D.)
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B9 5SS, UK
- Healthcare Management, School of Social Science, Hellenic Open University, 26331 Patra, Greece
| | - Lazaros Kostretzis
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, “G Gennimatas” Hospital, 54124 Thessaloniki, Greece; (L.K.); (I.S.); (P.P.); (K.D.)
| | - Athina Zacharoula Ditsiou
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Ioannis Samaras
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, “G Gennimatas” Hospital, 54124 Thessaloniki, Greece; (L.K.); (I.S.); (P.P.); (K.D.)
| | - Pericles Papadopoulos
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, “G Gennimatas” Hospital, 54124 Thessaloniki, Greece; (L.K.); (I.S.); (P.P.); (K.D.)
| | - Konstantinos Ditsios
- 2nd Orthopaedic Department of Aristotle, University of Thessaloniki, “G Gennimatas” Hospital, 54124 Thessaloniki, Greece; (L.K.); (I.S.); (P.P.); (K.D.)
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Wu JH, Bao QW, Wang SK, Zhou PY, Xu SG. Mechanisms of the Masquelet technique to promote bone defect repair and its influencing factors. Chin J Traumatol 2024:S1008-1275(24)00054-3. [PMID: 38734563 DOI: 10.1016/j.cjtee.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 05/13/2024] Open
Abstract
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.
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Affiliation(s)
- Jiang-Hong Wu
- Department of Emergency, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China; Department of Trauma Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Quan-Wei Bao
- Trauma Center, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China
| | - Shao-Kang Wang
- Department of Trauma Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Pan-Yu Zhou
- Department of Trauma Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Shuo-Gui Xu
- Department of Trauma Orthopedics, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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Mhiri A, Chermiti W, Hanafi A, Kaziz H, Naouar N, Bouattour K. Uncommon type 3 Monteggia equivalent lesion due to an ulnar shaft nonunion in adults: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241246879. [PMID: 38617996 PMCID: PMC11010738 DOI: 10.1177/2050313x241246879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
It is uncommon to observe a nonunion of an isolated ulnar shaft fracture after surgical treatment; therefore, complications due to this nonunion are very rare. Adults are more likely to develop nonunions compared to children. We report the case of a 34-year-old man, who had a left ulnar shaft fracture, treated with a screwed plate. Four months later, a septic nonunion occurred causing a type 3 Monteggia equivalent lesion with a lateral dislocation of the radial head. We describe the consecutive methods of treatment that resulted in complete bone consolidation. The case report aims to underline the diagnostic particularities and the therapeutic challenges of this rare complication.
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Affiliation(s)
- Amir Mhiri
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Wajdi Chermiti
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Aymen Hanafi
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Hamdi Kaziz
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Nader Naouar
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Karim Bouattour
- Department of Orthopedic Surgery, Sahloul Hospital, Sousse, Tunisia
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Richard MJ, Vu CL. Forearm Nonunions-From Masquelet to Free Vascularized Bone Grafting. Hand Clin 2024; 40:25-34. [PMID: 37979988 DOI: 10.1016/j.hcl.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Forearm fractures present a unique challenge due to the anatomic relationship of the radius relative to the ulna. Associated with the complexity of the treatment for these fractures is the management of nonunion and malunion of the radius and ulna. Evaluation and management of forearm nonunions require a critical evaluation of contributing factors prior to surgical intervention. Timely and precise treatment of nonunion and malunion is necessary to restore function of the forearm.
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Affiliation(s)
- Marc J Richard
- Division of Hand, Upper Extremity, and Microvascular Surgery, Duke University, Duke University Medical Center, 5601 Arringdon Park Drive, Suite 300, Morrisville, NC 27560, USA
| | - Catphuong L Vu
- Division of Hand, Upper Extremity, and Microvascular Surgery, Duke University, Duke University Medical Center, 5601 Arringdon Park Drive, Suite 300, Morrisville, NC 27560, USA.
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Feng D, Zhang Y, Wu W, Jia H, Ma C. Docking site complications analysis of Ilizarov bone transport technique in the treatment of tibial bone defects. J Orthop Surg Res 2023; 18:889. [PMID: 37993906 PMCID: PMC10666420 DOI: 10.1186/s13018-023-04356-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Treating long bone defects of the extremities caused by trauma, infection, tumours, and nonunion has been challenging for clinical orthopaedic surgeons. Bone transport techniques have the potential to treat bone defects. However, inevitable docking site complications related to bone transport techniques have been reported in many studies. The purpose of this study was to investigate the risk factors associated with docking site complications in patients who underwent the Ilizarov bone transport technique for the treatment of tibial bone defects. METHODS This retrospective study included 103 patients who underwent bone transport for the treatment of large bone defects in the tibia from October 2012 to October 2019. Patient demographic data, complications and clinical outcomes after a minimum of 2 years of follow-up were collected and retrospectively analysed. Additionally, univariate analysis and logistic regression analysis were used to analyse the factors that may affect the development of docking site complications in patients with tibial bone defects treated with the Ilizarov bone transport technique. The clinical outcomes were evaluated using the Association for the Study and Application of the Ilizarov criteria (ASAMI) at the last clinical follow-up. RESULTS All 103 patients with an average follow-up of 27.5 months. The docking site complications rate per patient was 0.53, and delayed union occurred in 22 cases (21.4%), axial deviation occurred in 19 cases (18.4%) and soft tissue incarceration occurred in 10 cases (9.7%). According to the results of the logistic regression analysis, the bone defect length (P = 0.001, OR = 1.976), and bone defect of distal 1/3 (P = 0.01, OR = 1.976) were significantly correlated with delayed union. Bone defect length (P < 0.001, OR = 1.981) and external fixation time (P = 0.012, OR = 1.017) were significantly correlated with axial deviation. Soft tissue defects (P = 0.047, OR = 6.766) and the number of previous operations (P = 0.001, OR = 2.920) were significantly correlated with soft tissue incarceration. The ASAMI bone score at the last follow-up showed a rate of excellent and good bone results of 95.1% and a rate of excellent functional results of 90.3%. CONCLUSION The Ilizarov bone transport technique is a practical and effective method for the treatment of tibial bone defects. However, the incidence of complications at the docking site is high, of which bone defect length, external fixation time, the number of previous operations, soft tissue defects and the bone defect of distal 1/3 are statistically significantly associated with the occurrence of docking site complications.
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Affiliation(s)
- Dongwei Feng
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Yaxin Zhang
- International Medical Services, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Weize Wu
- Department of Joint Surgery, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China
| | - Heping Jia
- Department of Pain, The First Affiliated Hospital of Hebei North University, Zhang Jiakou, Hebei, China.
| | - Chuang Ma
- Department of Orthopaedic, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Antoniac I, Manescu (Paltanea) V, Antoniac A, Paltanea G. Magnesium-based alloys with adapted interfaces for bone implants and tissue engineering. Regen Biomater 2023; 10:rbad095. [PMID: 38020233 PMCID: PMC10664085 DOI: 10.1093/rb/rbad095] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 10/03/2023] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Magnesium and its alloys are one of the most used materials for bone implants and tissue engineering. They are characterized by numerous advantages such as biodegradability, high biocompatibility and mechanical properties with values close to the human bone. Unfortunately, the implant surface must be adequately tuned, or Mg-based alloys must be alloyed with other chemical elements due to their increased corrosion effect in physiological media. This article reviews the clinical challenges related to bone repair and regeneration, classifying bone defects and presenting some of the most used and modern therapies for bone injuries, such as Ilizarov or Masquelet techniques or stem cell treatments. The implant interface challenges are related to new bone formation and fracture healing, implant degradation and hydrogen release. A detailed analysis of mechanical properties during implant degradation is extensively described based on different literature studies that included in vitro and in vivo tests correlated with material properties' characterization. Mg-based trauma implants such as plates and screws, intramedullary nails, Herbert screws, spine cages, rings for joint treatment and regenerative scaffolds are presented, taking into consideration their manufacturing technology, the implant geometrical dimensions and shape, the type of in vivo or in vitro studies and fracture localization. Modern technologies that modify or adapt the Mg-based implant interfaces are described by presenting the main surface microstructural modifications, physical deposition and chemical conversion coatings. The last part of the article provides some recommendations from a translational perspective, identifies the challenges associated with Mg-based implants and presents some future opportunities. This review outlines the available literature on trauma and regenerative bone implants and describes the main techniques used to control the alloy corrosion rate and the cellular environment of the implant.
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Affiliation(s)
- Iulian Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 050094 Bucharest, Romania
| | - Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
- Faculty of Electrical Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, National University of Science and Technology POLITEHNICA Bucharest, 060042 Bucharest, Romania
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Komura S, Hirakawa A, Hirose H, Yamamoto K, Matsushita Y, Matsumoto K, Akiyama H. Reconstruction of a severe comminuted distal radius fracture with a large segmental bone defect by dorsal bridge plating combined with a vascularized fibular graft: A case report. J Orthop Sci 2023; 28:1508-1512. [PMID: 34507872 DOI: 10.1016/j.jos.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Shingo Komura
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Akihiro Hirakawa
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hitoshi Hirose
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kyosuke Yamamoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yasuharu Matsushita
- Department of Rehabilitation Medicine, Gifu University Hospital, Gifu, Japan
| | - Kazu Matsumoto
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
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Zhao J, Wang Z, Long C, He H, Zhao W, Zhang J. Using 3D printing-assisted shaping titanium cages and Masquelet techniques to reconstruct calcaneal osteomyelitis complicated by extensive soft tissue and uncontrolled defects. Injury 2023; 54:110977. [PMID: 37684116 DOI: 10.1016/j.injury.2023.110977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To investigate the clinical efficacy of three-dimensional (3D) printing-assisted shaping titanium cage combined with Masquelet technology in the treatment of calcaneal infectious defects. METHODS A retrospective analysis was performed of the data from nine patients with chronic calcaneal infection defects treated with distal gastronal flap coverage and one patient with free anterolateral thigh flap coverage, also using a 3D printing-assisted shaping titanium cage combined with both mask technology and rib autografting from January 2017 to January 2019. There were seven males and three females, with a mean age of 37 years (range, 17-52 years). The injury mechanism of the 10 patients included four motor vehicle incidents, four high fall injuries, and two rolling compactions. All patients were treated by two⁃stage procedures. The first stage included debridement, polymethyl methacrylate (PMMA) filling, and regional flap coverage. The soft tissue defect of the 10 cases included 80 cm2 in four cases and 56 cm2, 40 cm2, and 15 cm2 in each of two cases. The bone defect was 24 cm3 and 18 cm3 in each of four cases and 3 cm3 in two cases. The second stage was the mask technology of 3D printing-assisted shaping titanium cage combined with rib autografting. Time of bone union, calcaneus morphology, implant position, and the Maryland and AOFAS hind foot scores were recorded to evaluate the clinical outcome. RESULTS All 10 patients were followed up for a mean of 18.5 months (range, 12-30 months). Infection occurred in two patients 2 months after the first stage operation and were successfully treated by debridement and PMMA replacement. The incision of the other eight cases all healed successfully. Cultures from the 10 cases included five cases of methicillin-resistant Staphylococcus aureus, three cases of S. aureus, and one case each of Escherichia coli and Pseudomonas aeruginosa. All 10 patients exhibited calcaneus bone union after the second stage operation. The mean time for bone union was 4.32 (range, 3-8) months. Bone trabeculae were observed in a CT scan 13 (range, 10-22) months post-operation. The mean Maryland score at 12 months post-operation was 92 (range, 86-98) and the mean AOFAS ankle hind foot score was 89.8 (range, 83-100). CONCLUSION Three-dimensional printing-assisted shaping titanium cages and Masquelet technology may be effective methods for the treatment of infectious calcaneal defects.
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Affiliation(s)
- Jianwen Zhao
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Zhifeng Wang
- First Orthopedic Surgery Department, Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Cheng Long
- Xiangya Hospital, Central South University, Department of Orthopedics, Changsha 410008, China
| | - Hongying He
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China
| | - Wei Zhao
- First Orthopedic Surgery Department, Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China
| | - Jianzheng Zhang
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Chinese Academy of Orthopedics, PLA General Hospital, Beijing 100048, China.
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11
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Serra Lopez VM, Wu CH, Bozentka DJ. Complications and Revision Surgery of Forearm Fractures. Hand Clin 2023; 39:295-306. [PMID: 37453758 DOI: 10.1016/j.hcl.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Nonunion or malunion of forearm fractures may result in restricted range of motion or persistent pain, leading to limitations in activities of daily living. Complications may also present in the form of ectopic bone growth or persistent infections. A systematic method to evaluate complications resulting from forearm fractures is helpful to both determine the cause for the failure and plan for adequate reconstruction.
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Affiliation(s)
- Viviana M Serra Lopez
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA.
| | - Chia H Wu
- Baylor College of Medicine, 7200 Cambridge Street, 10th Floor, Houston, TX 77030, USA
| | - David J Bozentka
- Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA 19104, USA
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Laubach M, Weimer LP, Bläsius FM, Hildebrand F, Kobbe P, Hutmacher DW. Complications associated using the reamer-irrigator -aspirator (RIA) system: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:3823-3843. [PMID: 36114869 PMCID: PMC10293355 DOI: 10.1007/s00402-022-04621-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Complications associated with the application of the Reamer-irrigator-Aspirator (RIA) system are described in the literature. However, to date a systematic review and meta-analysis to assess prevalence of complications associated with the use of the RIA system have not been conducted. MATERIALS AND METHODS The review is registered with PROSPERO (CRD42021269982). MEDLINE, the Web of Science Core Collection, and Embase were searched from the inception to 10 August 2021. The primary objective was to assess complications and blood loss associated with the use of the RIA system. RESULTS Forty-seven studies involving 1834 procedures performed with the RIA system were finally included. A total of 105 complications were reported, with a pooled estimated overall prevalence of 1.7% with a 95% confidence interval (CI) of 0.40 to 3.60, with cortex perforation being the largest reported complication with a total of 34 incidences. A significant subgroup difference was observed (p = 0.02). In subgroup 1 (bone graft harvesting), complication prevalence was 1.4% (95% CI 0.2-3.4); in subgroup 2 (clearance intramedullary canal) it was 0.7% (95% CI 0.00-6.30) and in subgroup 3 (reaming with RIA system prior to nail fixation) 11.9% (95% CI 1.80-26.40). No statistically significant difference for tibia and femur as RIA system application site was observed (CI 0.69-4.19). In studies reporting blood loss, a mean volume of 803.29 ml, a mean drop of hemoglobin of 3.74 g/dl and a necessity of blood transfusion in 9.72% of the patients were observed. CONCLUSIONS The systematic review and meta-analysis demonstrate a low overall prevalence rate of complications associated with the RIA system. However, especially the risk of cortical perforation and the frequently reported relevant intraoperative blood loss are complications that should be anticipated in perioperative management and ultimately considered when using the RIA system.
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Affiliation(s)
- Markus Laubach
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000 Australia
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Lucas P. Weimer
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands
| | - Felix M. Bläsius
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany
| | - Dietmar W. Hutmacher
- Australian Research Council (ARC) Training Centre for Multiscale 3D Imaging, Modelling, and Manufacturing (M3D Innovation), Queensland University of Technology, Brisbane, QLD 4000 Australia
- Australian Research Council (ARC) Training Centre for Cell and Tissue Engineering Technologies, Queensland University of Technology (QUT), Brisbane, QLD 4000 Australia
- Max Planck Queensland Center for the Materials Science of Extracellular Matrices, Queensland University of Technology, Brisbane, QLD 4000 Australia
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Jianmongkol S, Vinitpairot C. The 3D-Printed Titanium Truss Cage for the Treatment of Concurrent Complex Malunion, Synostosis and Large Bone Defect Following Forearm Injuries: A Case Report. J Hand Surg Asian Pac Vol 2023; 28:292-296. [PMID: 37120300 DOI: 10.1142/s2424835523720098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
A 28-year-old man sustained a complex forearm injury from high-energy trauma, causing ulnar nerve injury, a bone defect, forearm malunion and synostosis. A 3D-printed titanium truss cage was used to solve these problems. This patient achieved union of the bone defect, was pain-free and had no recurrent synostosis 2 years after reconstructive surgery. The advantages of the 3D-printed titanium truss cage included anatomical fit, immediate mobilisation and low morbidity of the donor side of the bone graft. This study reported a promising result from using 3D-printed titanium truss cages to manage complex forearm bony problems. Level of Evidence: Level V (Therapeutic).
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Affiliation(s)
- Surut Jianmongkol
- Hand and Reconstructive Unit, Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chaiyos Vinitpairot
- Hand and Reconstructive Unit, Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Management of gunshot-related forearm bone defect by sequential internal fixation and deferred bone grafting: experience from a tertiary hospital in Mogadishu. HAND SURGERY & REHABILITATION 2023; 42:28-33. [PMID: 36400417 DOI: 10.1016/j.hansur.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/17/2022]
Abstract
Gunshot-related forearm fractures are rare injuries, usually incurring bone defect. The aim of the study was to report clinical and radiological results for sequential internal fixation and bone grafting in acute civilian forearm gunshot fractures with bone defect. The procedure involves staged techniques consisting of bone debridement, soft-tissue closure and temporary intramedullary Kirschner wire fixation, followed by deferred bone grafting. To our knowledge, the present study is the first to investigate this surgical sequence in such injuries. Between June 2018 and September 2019, 6 civilian cases (5 male, 1 female) with a mean age of 26 years (range, 19-36 years) were operated on by sequential internal fixation and bone grafting for acute forearm gunshot fractures with segmental bone defect. Demographics, injury characteristics and surgical features were recorded. The Tang classification system was used to evaluate clinical and radiological results at final follow-up. Mean follow-up was 27 months (range: 21-32 months). Defect location was in the radius in 4 patients and in the ulna in 2, with a mean defect size of 3.75 cm (range, 2-8 cm). Union was achieved in 5 patients, at a mean 7 months (range, 4-10 months). Functional outcome was excellent in 4 patients, good in 1 and fair in 1. Sequential internal fixation and bone grafting seems a reliable option in the treatment of acute forearm gunshot fractures with bone defect. LEVEL OF EVIDENCE: Level IV - Retrospective study.
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Oka K, Kaji Y, Nakamura O, Yamaguchi K, Tobiume S, Nomura Y, Yamamoto T. Addition of a Vascular Bundle Accelerates Bone Union in Femoral Bone Defects. J Reconstr Microsurg 2023; 39:1-8. [PMID: 35272371 DOI: 10.1055/s-0042-1743256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Masquelet method has become increasingly popular for the treatment of bone defects in recent years. In this method, an induced membrane (IM) with abundant blood circulation, stem cells, and osteogenesis-promoting factors is formed by implanting bone cement during the first surgery. This IM stimulates bone formation in the bone defect after implantation of the bone graft during the second surgery. However, the Masquelet method requires two surgeries and thus a longer treatment period. In the present study, we investigated whether bone defects could be reconstructed in a single surgery by introducing a vascular bundle into the bone defect as an alternative to the IM, in addition to bone grafting. METHODS Thirty-six 12-week-old female Sprague-Dawley rats were used. After creating a 5-mm long bone defect in the femur, a mixture of autologous and artificial bone was grafted into the defect, and a saphenous arteriovenous vascular bundle was introduced. The animals were divided into three groups: the control group (bone defect only), the BG group (bone grafting only), and the BG + V group (bone grafting + vascular bundle introduction). After surgery, radiological and histological evaluations were performed to assess osteogenesis and angiogenesis in bone defects. RESULTS In the BG + V group, significant bone formation was observed in the bone defect on radiological and histological evaluations, and the amount of bone formation was significantly higher than that in the other two groups. Furthermore, cortical bone continuity was observed in many specimens in the BG + V group. On histological evaluation, the number of blood vessels was also significantly higher in the BG + V group than in the other two groups. CONCLUSION Our results suggest that the introduction of a vascular bundle in addition to bone grafting can promote bone formation in bone defects and allow for complete bone defect reconstruction in a single surgery.
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Affiliation(s)
- Kunihiko Oka
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Yoshio Kaji
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Osamu Nakamura
- Department of Orthopedic Surgery, Kagawa Prefectural Shirotori Hospital, Higashikagawa City, Kagawa, Japan
| | - Konosuke Yamaguchi
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Sachiko Tobiume
- Department of Orthopedic Surgery, Shikoku Medical Center for Children and Adults, Zentsuji City, Kagawa, Kagawa, Japan
| | - Yumi Nomura
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Tetsuji Yamamoto
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, Miki-Cho, Kita-gun, Kagawa, Japan
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El Farhaoui A, Benalia K, Lachkar A, abdeljaouad N, Yacoubi H. The induced membrane technique: A therapeutic option for managing bone defects in the upper extremity: Case series for 7 patients. Ann Med Surg (Lond) 2022; 81:104533. [PMID: 36147123 PMCID: PMC9486742 DOI: 10.1016/j.amsu.2022.104533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/21/2022] [Accepted: 08/27/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction The reconstruction of bone defects of tumoral, infectious or traumatic origin of the limbs remains a major therapeutic challenge for the orthopedic surgeon and the patient, in terms of anatomical and functional results. Cases presentation We report the case of 7 patients who underwent induced membrane bone reconstruction of the upper extremity, 5 patients with initial injury to the forearm, and 2 of our patients, to the humerus. In terms of function, the range of prono-supination was 125°, the range of wrist flexion-extension was 165°, and the range of elbow mobility was 170°. All patients achieved union at the time of the last follow-up. Two patients achieved union at 6 months, one patient at 5 months, one patient at 4 months, and three patients at 3 months. Discussion The induced membrane (IM) technique has been used for more than 30 years, and it's more and more widely accepted all over the world, as a simple and effective technique for reconstruction of segmental bone defects. The technique comprises 2 surgical stages, The first step involves the total excision of infected and non-viable lesions both bone and soft tissue until tissue with optimal vascularization "Paprika sign", then the strict instrumental stabilization of the skeleton and the realization of a covering flap if necessary, depending on the site of the initial injury initial lesion and the extent of the resection. Conclusion The technique of induced membrane has proven its effectiveness in the management of bone loss.
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Affiliation(s)
- Amine El Farhaoui
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
| | - Kamal Benalia
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
| | - Adnane Lachkar
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
| | - Najib abdeljaouad
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
| | - Hicham Yacoubi
- Faculty of Medicine and Pharmacy, Mohammed I University, Oujda, Morocco
- Department of Traumatology, Orthopedic Mohammed VI University Hospital Mohammed I University, Oujda, Morocco
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Rohilla R, Sharma PK, Wadhwani J, Das J, Singh R, Beniwal D. Prospective randomized comparison of bone transport versus Masquelet technique in infected gap nonunion of tibia. Arch Orthop Trauma Surg 2022; 142:1923-1932. [PMID: 33983526 DOI: 10.1007/s00402-021-03935-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/02/2021] [Indexed: 12/12/2022]
Abstract
AIM The present prospective randomized study compared the bone transport technique (BT) and Masquelet technique (MT) in the treatment of infected gap non-union of the tibia. PATIENTS AND METHODS Total 25 patients with infected gap non-union of the tibia with bone gap upto 6 cm were randomised into BT group (group I, 13 patients) and MT (group II, 12 patients). The mean age was 31.77 years in group I and 39.67 years in group II. The mean intra-operative bone gap was 3.92 cm in group I and 3.79 cm in group II. Monolateral fixator was applied in nine patients each in both groups, while four and three fractures were stabilized with ring fixators in group I and II, respectively. Mean follow-up was 31.62 months and 30.42 months in group I and II, respectively. Bone and functional results were compared using the association for the study and application of the method of Ilizarov (ASAMI) criteria. RESULTS The average fixator period was 9.42 and 16.33 months in group I and II, respectively (p < 0.001). Union was achieved in 12 (92%) patients and 6 (50%) patients in group I and II, respectively. The functional results were excellent (eight and two), good (four and six), fair (zero and three) and poor (one and one) in group I and II respectively, (p 0.23). The Bone results were excellent, good and poor in nine, three and one patients in group I, and three, three and six patients in group II respectively, (p 0.109). CONCLUSIONS The functional and bone results were comparable but more reliable in bone transport than the Masquelet technique. The fixator duration and incidence of non-union were higher in MT group. Ilizarov bone transport technique should be preferred in infected non-union of the tibia with bone loss upto 6 cm.
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Affiliation(s)
- Rajesh Rohilla
- Department of Sports Medicine, PGIMS, Pt. B. D. Sharma, Health University, Rohtak, 124001, Haryana, India
| | - Pankaj Kumar Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, Jodhpur Romana, Mandi Dabwali Road, Bathinda, 151001, Punjab, India.
| | - Jitendra Wadhwani
- Department of Orthopaedics, PGIMS, Pt. B. D. Sharma, Health University, Rohtak, 124001, Haryana, India
| | | | - Roop Singh
- Department of Orthopaedics, PGIMS, Pt. B. D. Sharma, Health University, Rohtak, 124001, Haryana, India
| | - Deepsikha Beniwal
- Department of Sports Medicine, PGIMS, Pt. B. D. Sharma, Health University, Rohtak, 124001, Haryana, India
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Xue N, Ding X, Huang R, Jiang R, Huang H, Pan X, Min W, Chen J, Duan JA, Liu P, Wang Y. Bone Tissue Engineering in the Treatment of Bone Defects. Pharmaceuticals (Basel) 2022; 15:879. [PMID: 35890177 PMCID: PMC9324138 DOI: 10.3390/ph15070879] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023] Open
Abstract
Bones play an important role in maintaining exercise and protecting organs. Bone defect, as a common orthopedic disease in clinics, can cause tremendous damage with long treatment cycles. Therefore, the treatment of bone defect remains as one of the main challenges in clinical practice. Today, with increased incidence of bone disease in the aging population, demand for bone repair material is high. At present, the method of clinical treatment for bone defects including non-invasive therapy and invasive therapy. Surgical treatment is the most effective way to treat bone defects, such as using bone grafts, Masquelet technique, Ilizarov technique etc. In recent years, the rapid development of tissue engineering technology provides a new treatment strategy for bone repair. This review paper introduces the current situation and challenges of clinical treatment of bone defect repair in detail. The advantages and disadvantages of bone tissue engineering scaffolds are comprehensively discussed from the aspect of material, preparation technology, and function of bone tissue engineering scaffolds. This paper also summarizes the 3D printing technology based on computer technology, aiming at designing personalized artificial scaffolds that can accurately fit bone defects.
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Affiliation(s)
- Nannan Xue
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Xiaofeng Ding
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Rizhong Huang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Ruihan Jiang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Heyan Huang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Xin Pan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Wen Min
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Jun Chen
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
| | - Jin-Ao Duan
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Pei Liu
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
| | - Yiwei Wang
- Jiangsu Provincial Engineering Research Center of Traditional Chinese Medicine External Medication Development and Application, Nanjing University of Chinese Medicine, Nanjing 210023, China; (N.X.); (X.D.); (R.H.); (R.J.); (H.H.); (W.M.); (J.C.)
- Jiangsu Collaborative Innovation Center of Chinese Medicinal Resources Industrialization, National and Local Collaborative Engineering Center of Chinese Medicinal Resources Industrialization and Formulae Innovative Medicine, Jiangsu Key Laboratory for High Technology Research of TCM Formulae, Nanjing University of Chinese Medicine, Nanjing 210023, China; (X.P.); (J.-A.D.)
- Burns Injury and Reconstructive Surgery Research, ANZAC Research Institute, University of Sydney, Concord Repatriation General Hospital, Concord 2137, Australia
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Dimartino S, Pavone V, Carnazza M, Cuffaro ER, Sergi F, Testa G. Forearm Fracture Nonunion with and without Bone Loss: An Overview of Adult and Child Populations. J Clin Med 2022; 11:jcm11144106. [PMID: 35887870 PMCID: PMC9319244 DOI: 10.3390/jcm11144106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/06/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Nonunion occurs in 2–10% of all forearm fractures due to different mechanical and biological factors, patient characteristics, and surgeon-dependent causes. It is a condition that causes functional and psychosocial disability for the patient because it is a unique anatomical segment in which all the bones and structures involved embody a complex functional unit; therefore, it is a challenge for the orthopedic surgeon. The ultimate goal of the care of these patients is the restoration of function and limitations related to impairment and disability. The aim of this review is to provide an extended description of nonunion forearm fractures, related risk factors, diagnosis, classification systems, and the available evidence for different types of treatment as a tool to better manage this pathology.
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Wang J, Du Z, Yang R, Tang X, Guo W. Analysis of mechanical complications for patients with extremity sarcoma after biological reconstruction. Orthop Traumatol Surg Res 2022; 108:102872. [PMID: 33667737 DOI: 10.1016/j.otsr.2021.102872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Biological reconstruction after tumor resection is significant for restoration of limb integrality. However, it is unclear what risk factors influence mechanical complications of patients after extremity sarcoma resection and biological reconstruction. The objective of study was (1) to compare complications between patients receiving inactivated autograft and allograft, (2) to analyze influence of graft type, nonunion and fixation method on mechanical complications for patients after biological reconstruction. HYPOTHESIS We hypothesized allograft, nonunion and fixation method influence occurrence of mechanical complications after biological reconstruction. MATERIALS AND METHODS We retrospectively reviewed 71 patients with sarcomas at the extremity receiving biological reconstruction from January 1999 to November 2015. Eight patients were lost at last follow-up. Sixty-three patients with complete clinical data were recruited into the present study. There were 32 males and 31 females with a mean age of 20.5±14.9 years (median, 17 years; range, 2-72 years). Sixty-one cases had tumors at lower extremity and two at upper extremity. Histological diagnosis was confirmed as forty-five with osteosarcoma, thirteen with Ewing sarcoma and five with chondrosarcoma. RESULTS Forty-four patients were free of disease, sixteen died of disease and three lived with pulmonary metastasis at last follow-up. Twenty-one out of 63 patients (33.3%) had local recurrence requiring surgical treatment. Reconstruction choice (mechanical complications rates were 38.9% for allograft (14/36) versus 14.8% for inactivated autograft (4/27)) and nonunion occurrence (yes 58.8% (10/17); no 17.4% (8/46)) had the close relationship with mechanical complication in the univariate analysis. The multivariate analysis revealed fixation method (p=0.041) and nonunion (p=0.008) were prognostic factors for mechanical complication of sarcoma resection and biological reconstruction at the extremity. Fourteen of 36 patients receiving massive allograft had a second surgery due to mechanical complication compared to 4 of 27 patients with massive inactivated autograft (38.9%, 14/36 vs. 14.8%, 4/27 (p=0.05)). Time to union for diaphysis and metaphysis was not significantly different between allograft and inactivated autograft groups. DISCUSSION Patients receiving massive allograft are prone to suffer from the mechanical complications. Extramedullary plate and nonunion have the tendency of increasing occurrence of mechanical complications of biological reconstruction. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- Jun Wang
- Peking University People's Hospital, Musculoskeletal Tumor Center, N(o) 11, Xizhimen South Street, 100044 Beijing, China
| | - Zhiye Du
- Peking University People's Hospital, Musculoskeletal Tumor Center, N(o) 11, Xizhimen South Street, 100044 Beijing, China
| | - Rongli Yang
- Peking University People's Hospital, Musculoskeletal Tumor Center, N(o) 11, Xizhimen South Street, 100044 Beijing, China
| | - Xiaodong Tang
- Peking University People's Hospital, Musculoskeletal Tumor Center, N(o) 11, Xizhimen South Street, 100044 Beijing, China
| | - Wei Guo
- Peking University People's Hospital, Musculoskeletal Tumor Center, N(o) 11, Xizhimen South Street, 100044 Beijing, China.
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Induced Membrane Technique for the Treatment of Infected Forearm Nonunion: A Retrospective Study. J Hand Surg Am 2022; 47:583.e1-583.e9. [PMID: 34563414 DOI: 10.1016/j.jhsa.2021.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Infected forearm nonunion remains a challenge for the hand surgeon. Autologous bone grafting within an induced membrane following implantation of a cement spacer, also known as the Masquelet technique, is a procedure used for addressing segmental bone defects. This report summarized our experience using this technique to treat the infected forearm nonunion. METHODS We retrospectively reviewed a series of 32 patients treated for infected forearm nonunion by the 2-stage Masquelet technique between 2009 and 2018. There was an infected nonunion of the ulna in 28 patients and an infected nonunion of the radius in 4 patients. All patients had undergone an average of 2.7 procedures before presenting at our institution. Treatment involved a staged procedure in which an antibiotic-impregnated cement spacer was implanted into the bone defect following debridement without internal fixation. It was left in place for 4-6 weeks, during which time a membrane formed around the cement spacer. In the second stage, the induced membrane was incised, and the cement spacer was removed. The defect was then filled with cancellous autograft with the addition of internal fixation. Postoperative radiographs were taken for the evaluation of bone healing. The functional results of the affected forearm were evaluated for motion loss of elbow or wrist and rotation loss of forearm. RESULTS All nonunions healed without recurrent infection or loosening of internal fixation at the time of final follow-up. All the patients showed substantial functional improvement, with excellent results in 14 patients, satisfactory results in 13, and unsatisfactory results in 5. CONCLUSIONS The induced membrane technique is an effective solution for infected forearm nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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O’Connor CM, Perloff E, Drinane J, Cole K, Marinello PG. An Analysis of Complications and Bone Defect Length With the Use of Induced Membrane Technique in the Upper Limb: A Systematic Review. Hand (N Y) 2022; 17:572-577. [PMID: 32666849 PMCID: PMC9112749 DOI: 10.1177/1558944720918368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: The induced membrane technique was originally described as a technique for the reconstruction of long bone defects. The authors performed a systematic review to determine whether the use of the induced membrane technique is effective in large bony defects in the upper extremity. Methods: A qualitative systematic review was conducted using PubMed, EBSCO, and Google Scholar databases to record all studies reporting on complications of the induced membrane technique in the upper extremity. Studies written after 1990 in English language journals met the inclusion criteria. Exclusion criteria were non-English language publications, animal studies, failure to identify the location of the bone defect, failure to identify whether complications were associated with the procedure, and failure to define the length of bone defect. Results: A total of 1422 studies were identified in the original search. Twelve studies satisfied the criteria for inclusion. A total of 70 patients with 83 upper extremity cases were reported: 1 proximal interphalangeal joint, 22 phalanges, 8 metacarpals, 37 forearms, 14 humeri, and 1 clavicle. The mean bone defect size was 4.0 cm (SD, 1.5). The most common complication was infection. We found that complication rates were independent of the location of the bone defect. Complication rates in the upper extremity ranged from 0% to 100%, with a total weighted mean of 10%. Conclusion: The induced membrane technique is an emerging possible treatment of large bone defects in the upper extremity. More research is needed to determine the outcomes of the induced membrane technique in the upper extremity.
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Affiliation(s)
- Casey M. O’Connor
- Albany Medical Center, NY, USA,Casey M. O’Connor, Department of Orthopedic Surgery, Albany Medical Center, 43 New Scotland Road, Albany, NY 12208, USA.
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Outcomes After Use of the Induced Membrane Technique for Fractures of the Upper Extremity. J Hand Surg Am 2022:S0363-5023(22)00058-2. [PMID: 35304008 DOI: 10.1016/j.jhsa.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 11/17/2021] [Accepted: 01/12/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to review a series of cases in which the induced membrane technique was used for fractures with segmental bone loss in the upper extremity. We aimed to examine patient indications, outcomes based on union rates, and complications associated with this technique. METHODS An institutional review board-approved database at our institution was used to identify patients based on either diagnosis or procedure codes commonly used during the induced membrane treatment. The database was queried between 2003 and 2020 and included patients with segmental bone defects from acute trauma, nonunions, and infections. Demographic data, mechanism of injury, size and extent of the bone defect, treatment indication and methods along with intraoperative and postoperative complications were retrospectively reviewed. RESULTS We identified 23 patients who met our inclusion criteria, including 15 patients with traumatic segmental bone loss and 8 patients with chronic nonunions and/or infections. Fourteen cases involving the bones of the forearm, 8 cases involving the metacarpals and 3 cases involving the phalanges were identified. Radiographic union was ultimately demonstrated in 21/23 patients (91.3%) with a median time to union of 20 weeks (range 13-29 weeks). A total of 10 patients required unplanned reoperation, with 4 nonunions requiring repeat plating and grafting procedures, and 1 patient ultimately underwent amputation for persistent infection. CONCLUSIONS The induced membrane technique represents an effective treatment option for acute traumatic bone loss as well as chronic fracture nonunions. The technique has potential challenges, as 10 patients (43.5%) in our series required unplanned reoperations with 4 patients (17.4%) requiring a repeat intervention for persistent nonunion. TYPE OF STUDY/LEVEL OF EVIDENCE THERAPEUTIC IV.
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VICENTI G, OTTAVIANI G, BIZZOCA D, CARROZZO M, SIMONE F, GROSSO A, ZAVATTINI G, ELIA R, MARUCCIA M, SOLARINO G, MORETTI B. The role of biophysical stimulation with pemfs in fracture healing: from bench to bedside. MINERVA ORTHOPEDICS 2022. [DOI: 10.23736/s2784-8469.21.04116-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Masquelet technique for infected distal radius fractures with gaps in paediatric age group. Trauma Case Rep 2022; 37:100568. [PMID: 34977319 PMCID: PMC8683642 DOI: 10.1016/j.tcr.2021.100568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/24/2021] [Accepted: 12/04/2021] [Indexed: 11/23/2022] Open
Abstract
The management of infected nonunion with bone loss is always challenging. The Masquelet technique is an excellent option available for us today. However, there are few reports of its use in the paediatric age group and no reports of its use especially in infected distal radius fractures or nonunion. We report on two children with infection and significant bone loss after open fractures of the distal radius which we have treated successfully using a modified Masquelet technique.
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Case report: Forearm infected non-united fracture managed with the Masquelet technique in a 71-year-old female patient. Trauma Case Rep 2021; 36:100562. [PMID: 34901373 PMCID: PMC8640105 DOI: 10.1016/j.tcr.2021.100562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
Infected non-union status post forearm fracture fixation is a challenge to treat and may be associated with unpredictable outcomes. The management of such a case involving a 71-year-old female suffering from Parkinson's disease is reported herein. The patient referred to our unit for a second opinion while she was under consideration for amputation at her local hospital. Utilising the two stage Masquelet technique successful limb salvage and excellent function were achieved.
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Commeil P, Seguineau A, Delesque A, Erbland A, Harly E, Lecoanet P, Fabre T, Dunet B. Post-traumatic forearm bone defect reconstruction using the induced membrane technique. Orthop Traumatol Surg Res 2021; 107:103036. [PMID: 34365022 DOI: 10.1016/j.otsr.2021.103036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 09/27/2020] [Accepted: 02/02/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The induced membrane technique, first described by Masquelet, is now well standardized, but little studied in post-traumatic forearm bone defect. The main aim of the present study was to analyze consolidation rates in this indication. The study hypothesis was that the induced membrane technique provides good consolidation results. METHODS We performed a retrospective assessment of our experience with 10 cases of induced membrane forearm reconstruction. The two main etiologies were acute trauma or treatment for non-union. Functional impact was assessed on range of motion and QuickDASH. The complications rate was also examined. RESULTS There were 3 cases of post-traumatic bone defect, and 7 of non-union treatment, including 6 septic non-unions. Mean defect size was 4.3cm. Mean interval between induced membrane stages 1 and 2 was 3.3 months. Pure cancellous iliac bone graft was systematic. Nine of the patients showed consolidation, at a mean 9.2 months; there was 1 case of non-consolidation, but no other complications. Range of motion was satisfactory; mean QuickDASH score was 22 at a mean 50.3 months' follow-up. CONCLUSION The induced membrane technique was reliable, reproducible and technically accessible, with good functional and radiographic results and few complications. LEVEL OF EVIDENCE IV; retrospective study without control group.
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Affiliation(s)
- Paul Commeil
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France.
| | - Arthur Seguineau
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France
| | - Alison Delesque
- Service de chirurgie orthopédique et traumatologique, centre hospitalier Libourne, 112, rue de la Marne, 35000 Libourne cedex, France
| | - Alexandra Erbland
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France
| | - Edouard Harly
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France
| | - Paul Lecoanet
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier Libourne, 112, rue de la Marne, 35000 Libourne cedex, France
| | - Thierry Fabre
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France
| | - Bertrand Dunet
- Service de chirurgie orthopédique et traumatologique, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux cedex, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier Libourne, 112, rue de la Marne, 35000 Libourne cedex, France
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Induced membrane technique applied to the forearm: Technical refinement, indications and results of 13 cases. Orthop Traumatol Surg Res 2021; 107:103074. [PMID: 34563733 DOI: 10.1016/j.otsr.2021.103074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 02/23/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The unique anatomical characteristics of the forearm bones makes their reconstruction challenging. The aim of this study was to report the surgical methods and results of the induced membrane technique applied to traumatic forearm bone defects. MATERIAL AND METHODS We evaluated retrospectively a case series of 13 patients operated between 2010 and 2017. The first surgical step consisted of debridement of the fracture site and implantation of a cement spacer with appropriate fixation. The anatomy of the forearm skeleton had to be restored. The second step, done 6 weeks later, consisted of removing the cement spacer and applying cancellous bone autograft harvested from the iliac crest. The outcome measures were radiological bone union, need for surgical revision, and postoperative wrist range of motion. RESULTS All 13 patients were men, with a mean age of 39 years (18-67). The average follow-up was 2.5 years. Eleven patients were suffering from a nonunion and two from a post-traumatic bone defect. Six patients had an identified preoperative infection. Three patients had previously undergone an unsuccessful treatment for their nonunion with bone addition. The maximum length of bone reconstruction was 12 cm. Union was achieved in 12 of 13 patients in a mean of 5 months (3-8). The other patient died during the postoperative course. Two patients needed revision surgery: ulnar shortening osteotomy (1 case) and additional tendon reconstruction (1 case). The mean pronosupination range was 123° on average (55-180°). The mean flexion-extension range was 106° (90-130°). CONCLUSION The induced membrane technique is a reliable reconstruction technique that is well suited to reconstruction of the forearm skeleton. LEVEL OF EVIDENCE IV, retrospective study.
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Abstract
OBJECTIVES To evaluate a large series of open fractures of the forearm after gunshot wounds (GSWs) to determine complication rates and factors that may lead to infection, nonunion, or compartment syndrome. DESIGN Multicenter retrospective review. SETTING Nine Level 1 Trauma Centers. PATIENTS/PARTICIPANTS One hundred sixty-eight patients had 198 radius and ulna fractures due to firearm injuries. All patients were adults, had a fracture due to a firearm injury, and at least 1-year clinical follow-up or follow-up until union. The average follow-up was 831 days. INTERVENTION Most patients (91%) received antibiotics. Formal irrigation and debridement in the operating room was performed in 75% of cases along with either internal fixation (75%), external fixation (6%), or I&D without fixation (19%). MAIN OUTCOME MEASURES Complications including neurovascular injuries, compartment syndrome, infection, and nonunion. RESULTS Twenty-one percent of patients had arterial injuries, and 40% had nerve injuries. Nine patients (5%) developed compartment syndrome. Seventeen patients (10%) developed infections, all in comminuted or segmental fractures. Antibiotics were not associated with a decreased risk of infection. Infections in the ulna were more common in fractures with retained bullet fragments and bone loss. Twenty patients (12%) developed a nonunion. Nonunions were associated with high velocity firearms and bone defect size. CONCLUSIONS Open fractures of the forearm from GSWs are serious injuries that carry high rates of nonunion and infection. Fractures with significant bone defects are at an increased risk of nonunion and should be treated with stable fixation and proper soft-tissue handling. Ulna fractures are at a particularly high risk for deep infection and septic nonunion and should be treated aggressively. Forearm fractures from GSWs should be followed until union to identify long-term complications. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Ferreira N, Saini AK, Birkholtz FF, Laubscher M. Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:911-922. [PMID: 33674937 DOI: 10.1007/s00590-021-02887-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Injuries to the long bones of the upper limb resulting in bone defects are rare but potentially devastating. Literature on the management of these injuries is limited to case reports and small case series. The aim of this study was to collate the most recent published work on the management of upper limb bone defects to assist with evidence based management when confronted with these cases. METHODS Following a preliminary search that confirmed the paucity of literature and lack of comparative trials, a scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of upper limb long bone defects published between 2010 and 2020. RESULTS A total of 46 publications reporting on the management of 341 patients were reviewed. Structural autograft, bone transport, one-bone forearm and the induced membrane technique were employed in an almost equal number of cases. The implemented strategies showed similar outcomes but different indications and complication profiles were observed. CONCLUSION Contemporary techniques for the management of post-traumatic upper limb bone defects all produce good results. Specific advantages, disadvantages and complications for each modality should be considered when deciding on which management strategy to employ for each specific patient, anatomical location, and defect size.
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Affiliation(s)
- Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa.
| | - Aaron Kumar Saini
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, 7505, South Africa
| | - Franz Friedrich Birkholtz
- Walk-A-Mile Centre and Department of Orthopaedics, University of Pretoria, Pretoria, 0002, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit (ORU), Division of Orthopaedic Surgery, Department of Surgery, University of Cape Town, Cape Town, 7505, South Africa
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Liu Y, Yushan M, Liu Z, Liu J, Ma C, Yusufu A. Treatment of diaphyseal forearm defects caused by infection using Ilizarov segmental bone transport technique. BMC Musculoskelet Disord 2021; 22:36. [PMID: 33413259 PMCID: PMC7789280 DOI: 10.1186/s12891-020-03896-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Ilizarov segmental bone transport technique can be applied in the reconstruction of the bone defects with less invasive fashion and more versatility compared to other methods, while most studies were focused on the lower extremity. The purpose of this study was to evaluate the effectiveness of the Ilizarov segmental bone transport technique in the treatment of diaphyseal forearm bone defects caused by infection. Methods This study included 12 patients with diaphyseal forearm bone defects caused by infection, who underwent bone transport procedures using the monolateral external fixator at our institution from January 2010 to January 2018, including 10 males and 2 females with a mean age of 39 years (range 23–57 years). Patient’s demographic data and clinical outcomes at least two years follow-up after removing the external fixator were collected and retrospectively analyzed. The functional results were evaluated by the questionnaire of Disability of Arm, Shoulder and Hand (DASH) and the modified Mayo wrist score (MWS) at the final follow-up. Results There were 10 radii and 2 ulnae bone transport procedures collected. The average defect size was 5.1 cm (4-6.5 cm). All patients were successfully followed up with a mean period of 28.2 months (24 to 36 months) and achieved infection-free union. There was no recurrence of infection observed. The mean external fixation time was 232.6 days (182 to 276 days), and the mean external fixation index was 46.3 days/cm (40.9 to 61.8 days/cm). The mean DASH score was 30.6(18 to 49) preoperative, while 13.8 (5 to 26) at the final follow-up. The average modified MWS improved from 68.8 (55 to 80) pre-operatively to 83.8 (65 to 90) at the final follow-up. All the differences between the preoperative and final scores were statistically significant (p < 0.05). Almost all the patients achieved satisfactory clinical outcomes and were able to perform activities of daily living. Conclusions Ilizarov segmental bone transport technique is an alternative and effective method for the treatment of diaphyseal forearm bone defects caused by infection, and this method acquired satisfactory clinical outcomes.
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Affiliation(s)
- Yanshi Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Maimaiaili Yushan
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jialin Liu
- Department of Prosthodontics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Chuang Ma
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Aihemaitijiang Yusufu
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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Fung B, Hoit G, Schemitsch E, Godbout C, Nauth A. The induced membrane technique for the management of long bone defects. Bone Joint J 2020; 102-B:1723-1734. [PMID: 33249891 DOI: 10.1302/0301-620x.102b12.bjj-2020-1125.r1] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AIMS The purpose of this study was to: review the efficacy of the induced membrane technique (IMT), also known as the Masquelet technique; and investigate the relationship between patient factors and technique variations on the outcomes of the IMT. METHODS A systematic search was performed in CINAHL, The Cochrane Library, Embase, Ovid MEDLINE, and PubMed. We included articles from 1 January 1980 to 30 September 2019. Studies with a minimum sample size of five cases, where the IMT was performed primarily in adult patients (≥ 18 years old), in a long bone were included. Multivariate regression models were performed on patient-level data to determine variables associated with nonunion, postoperative infection, and the need for additional procedures. RESULTS A total of 48 studies were included, with 1,386 cases treated with the IMT. Patients had a mean age of 40.7 years (4 to 88), and the mean defect size was 5.9 cm (0.5 to 26). In total, 82.3% of cases achieved union after the index second stage procedure. The mean time to union was 6.6 months (1.4 to 58.7) after the second stage. Our multivariate analysis of 450 individual patients showed that the odds of developing a nonunion were significantly increased in those with preoperative infection. Patients with tibial defects, and those with larger defects, were at significantly higher odds of developing a postoperative infection. Our analysis also demonstrated a trend towards the inclusion of antibiotics in the cement spacer having a protective effect against the need for additional procedures. CONCLUSION The IMT is an effective management strategy for complex segmental bone defects. Standardized reporting of individual patient data or larger prospective trials is required to determine the optimal implementation of this technique. This is the most comprehensive review of the IMT, and the first to compile individual patient data and use regression models to determine predictors of outcomes. Cite this article: Bone Joint J 2020;102-B(12):1723-1734.
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Affiliation(s)
- Benjamin Fung
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, Canada
| | - Graeme Hoit
- Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Emil Schemitsch
- Department of Surgery, London Health Sciences Centre, London, Canada
| | - Charles Godbout
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada.,Bruyère Research Institute, Ottawa, Canada
| | - Aaron Nauth
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.,Division of Orthopaedic Surgery, St. Michael's Hospital, Toronto, Canada
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Sauerbier M, Maldonado AA, Hoffmann R, Kuz N. [Possible applications of free microsurgical fibula transplantation in the reconstruction of complex bone defects in the extremities: review of the literature and case series]. HANDCHIR MIKROCHIR P 2020; 52:505-517. [PMID: 32820485 DOI: 10.1055/a-1183-4532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Extensive osseous defects of the extremities following trauma and tumour resection represent a major challenge for plasticreconstructive surgical teams. Defect reconstruction by free microsurgical fibula transplantation has become a standard method but is associated with a considerable rate of complications. The aim of the present work is to provide an up-to-date overview of the various reconstruction methods and to report our personal experiences with free fibula transplantation in a case series. PATIENTS AND METHODS The literature search on the subject was performed on Pubmed and Web of Science, and a retrospective collection of data was conducted based on our own cases, including clinical and radiological data. RESULTS From 2007 to 2018, free fibula transplantation was performed in 11 patients under the guidance of the senior author (MS). The defects were a result of pseudarthrosis in four cases, osteitis in three, and a tumour in two cases. Two patientssustained a primary defect due to a high-energy trauma. In nine cases the upper limb was affected; only two had the defect in the lower limb. No graft failure was observed. In eight cases, an osteoseptocutaneous graft was taken; in two cases there was a post-operative loss of the skin island. Fibula length ranged between 5 and 22 cm. In all cases, bony integration of the graft was complete. The range of motion in the affected limb after physiotherapy was very good to satisfactory. CONCLUSION Extensive bone defect reconstruction using free fibula flaps is undoubtedly the gold standard method, but the high rate of complications described in the literature necessitates a strict indication in due consideration of possible alternatives. Close cooperation between the disciplines of plastic reconstructive surgery and trauma orthopaedics is indispensable.
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Affiliation(s)
- Michael Sauerbier
- PROFESSOR SAUERBIER, Privatärztliche Praxis für Hand- und Plastische Chirurgie, Bad Homburg v. d. Höhe
| | - Andres A Maldonado
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Abteilung für Plastische, Hand- und -Rekonstruktive Chirurgie
| | - Reinhard Hoffmann
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Unfallchirurgie und Orthopädische Chirurgie
| | - Nikolai Kuz
- Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Abteilung für Plastische, Hand- und -Rekonstruktive Chirurgie
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Srinivasan RC, Hutson RL, Richard MJ. Forearm Nonunion: Characterization and Management. J Hand Surg Am 2020; 45:1055-1064. [PMID: 32800376 DOI: 10.1016/j.jhsa.2020.05.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 02/16/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023]
Abstract
Adult forearm nonunion should be investigated prior to developing a treatment strategy: "Why did the fracture not heal?" Optimizing the patient's biology and the stability at the nonunion site are critical for a successful outcome. This review concisely discusses the initial work-up, including history, physical examination, imaging, and laboratory testing, as well as available surgical techniques-irrigation and debridement with deep cultures, revision open reduction internal fixation with or without biological adjuvant therapies, cancellous autograft, tricortical iliac crest, reamer/irrigator/aspirator, allograft, vascularized free-fibula and induced-membrane technique.
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Affiliation(s)
- Ramesh C Srinivasan
- Hand Center of San Antonio, Department of Orthopedic Surgery, University of Texas Health San Antonio, San Antonio, TX.
| | - Russell L Hutson
- Hand Center of San Antonio, Department of Orthopedic Surgery, University of Texas Health San Antonio, San Antonio, TX
| | - Marc J Richard
- Department of Orthopedic Surgery, Duke University, Durham, NC
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Adding a Fibular Strut Allograft to Intramedullary Nail and Cancellous Autograft During Stage II of the Masquelet Technique for Segmental Femur Defects: A Technique Tip. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e1900179. [PMID: 32672724 PMCID: PMC7366422 DOI: 10.5435/jaaosglobal-d-19-00179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Reconstruction of segmental diaphyseal bone defects has been a major challenge in limb salvage surgery. Staged reconstruction as first described by Masquelet is a common strategy to deal with this problem in limb salvage surgery. One consequence of this technique is a time period of prolonged limited weightbearing while the segmental defect heals. The purpose of this study was to describe an adjunctive technique for stage II of the Masquelet procedure and retrospectively analyze the outcome and weight bearing progression of 3 patients who sustained femur fractures with significant bone loss and underwent this technique. A retrospective chart review was performed. The patients (2 males, 1 female with an average age of 36.6 years) all sustained segmental femur fractures which resulted in significant bone loss. Induced membrane technique with adjunct use of a fibular strut allograft was performed after initial stabilization and PMMA spacer placement. All three patients went on to union and full weight bearing after being treated by the described technique. All the patients were allowed toe-touch weight bearing immediately after surgery and all progressed to weight bearing as tolerated at an average of 3.6 months. Using a fibular strut allograft as an adjunct to the induced membrane technique serves as a biologic and mechanical scaffold and may allow earlier weightbearing.
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Wang S, Li Y, Li S, Yang J, Tang R, Li X, Li L, Fei J. Platelet-rich plasma loaded with antibiotics as an affiliated treatment for infected bone defect by combining wound healing property and antibacterial activity. Platelets 2020; 32:479-491. [PMID: 32396493 DOI: 10.1080/09537104.2020.1759792] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
To be faced with an infected bone defect and the need to accelerate bone union while controlling infection is a welcome challenge for orthopedists. Platelet-rich plasma (PRP) has been applied in tissue defects given their composition of growth factors however the weak antibacterial effects have limited the use of PRP in the clinical setting. Therefore, the aim of this study was to explore the feasibility of using PRP in a local antibiotic delivery system (PADS) with the characteristics of promoting wound healing of bone infection. PADS was prepared with the addition of antibiotics or no antibiotics as control after PRP was prepared by a two-step centrifugation procedure. Antibacterial tests showed zones of inhibition produced by antibiotics were not significantly different with antibiotics combined with PRP. HPLC analysis demonstrated that about 60% of the total vancomycin (VAN) and ceftazidime (CAZ) dose were released within 10 min, then the release rate gradually decreased. However, 90% clindamycin was released within 10 min. Interestingly, above 10 times the minimum inhibitory concentration was presented after 72 h. Additionally, ELISA and morphology studies of PADS indicated that loaded antibiotics could reduce the PRP-released growth factor concentration and disturb the structure of platelet-fibrin beams and fibrin network in a dose-dependent manner. Fortunately, the lower dose of antibiotics maintained their anti-microbial effect, meanwhile growth factors released from PADS, the structure of platelet-fibrin beams, fibrin network remained unaffected. In addition, a patient experiencing infected bone defect receiving this PADS treatment achieved union within the 15-month follow-up. Therefore, this novel PADS approach might represent a potential therapy for patients who have sustained infected bone defects.
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Affiliation(s)
- Shaochuan Wang
- Department of Emergency Medicine of Daping Hospital, Army Medical University, Chongqing, China
| | - Youbin Li
- Department of Emergency Medicine of Daping Hospital, Army Medical University, Chongqing, China
| | - Shidan Li
- Department of Emergency Medicine of Daping Hospital, Army Medical University, Chongqing, China
| | - Jing Yang
- Department of Emergency Medicine of Daping Hospital, Army Medical University, Chongqing, China
| | - Ruohui Tang
- Department of Emergency Medicine of Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoming Li
- Department 4, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Lei Li
- Department of Immunity and Infection, Research Institute of Surgery, Army Medical University, Chongqing, China
| | - Jun Fei
- Department of Emergency Medicine of Daping Hospital, Army Medical University, Chongqing, China.,State Key Laboratory of Trauma, Burns and Combined Injury, Army Medical University, Chongqing, China
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Abstract
An infected diaphyseal forearm nonunion can be a challenge. After several failed salvage procedures, the patient can be left with residual pain, shortening, bone loss, and poor soft tissue envelope. Keystones for infected nonunion treatment are debridement, cultures, antibiotics, stability, and restore alignment. This report describes the current literature on the treatment of forearm nonunion, and we present a case of a recalcitrant infected ulna nonunion that ultimately healed after 12 surgeries.
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Affiliation(s)
- Niels Bech
- Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, NLD
| | - Peter Kloen
- Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, NLD
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Bourgeois M, Loisel F, Bertrand D, Nallet J, Gindraux F, Adam A, Lepage D, Sergent P, Leclerc G, Rondot T, Garbuio P, Obert L, Pluvy I. Management of forearm bone loss with induced membrane technique. HAND SURGERY & REHABILITATION 2020; 39:171-177. [PMID: 32061857 DOI: 10.1016/j.hansur.2020.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/15/2022]
Abstract
There are very few published studies describing the treatment of segmental bone defects of the forearm using the induced membrane technique. The objectives of this study were to evaluate the time to bone union, the function of the joints above and below the treated bone segment and the patients' quality of life over the long-term. We performed a retrospective study in all patients treated by the induced membrane for a forearm bone defect over at 13-year period. Demographics, bone union, complications, functional outcomes and occupational status were collected. Six patients were included: 2 posttraumatic injuries, 1 osteomyelitis, 1 septic arthritis, 1 aseptic nonunion, 1 tumor. The average defect length was 64mm (48-110). All defects were treated with internal fixation. Bone graft was harvested from the iliac crest in two patients, the femur (using the Reamer Irrigator Aspirator technique) in three patients and the radius in one patient. Five patients achieved bone union after a mean of 4months (3-6). Three complications were observed: 1 radioulnar instability, 1 infection of the fixation device, 1 abscess. At an average 8½ years' follow-up, the pain level on the VAS was 0.6 (0-3), the Mayo Elbow Performance Score was 98 (90-100), the Herzberg score was 108 (85.6-140) and the QuickDASH was 14.9 (2.7-35). All patients returned to work. Using the induced membrane technique avoids the complications associated with vascularized autograft and yields good functional outcome and quality of life.
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Affiliation(s)
- M Bourgeois
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France.
| | - F Loisel
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - D Bertrand
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - J Nallet
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - F Gindraux
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - A Adam
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - D Lepage
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - P Sergent
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - G Leclerc
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - T Rondot
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France
| | - P Garbuio
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - L Obert
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
| | - I Pluvy
- Service de chirurgie orthopédique, traumatologique et plastique, CHRU de Besançon, boulevard Fleming, 25030 Besançon cedex, France; EA 4662 nanomédecine, imagerie, thérapeutique, UFR sciences & techniques, université de Franche-Comté, 16, route de Gray, 25030 Besançon cedex, France
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39
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Affiliation(s)
- Meng Mi
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | | | - Xinbao Wu
- Department of Orthopaedics and Traumatology, Beijing Jishuitan Hospital, Beijing, China
| | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedic, School of Medicine, University of Leeds, Leeds General Infirmary, Leeds, UK; NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK.
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40
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Staged arthrodesis using the Masquelet technique for osteomyelitis of the finger with articular destruction: a report of two cases. Arch Orthop Trauma Surg 2019; 139:1025-1031. [PMID: 31093754 DOI: 10.1007/s00402-019-03197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Indexed: 02/09/2023]
Abstract
Osteitis of the fingers is a serious infection that needs early diagnosis and appropriate surgical debridement and antibiotic treatment of the infected bone. If the effects of treatments are insufficient, long-term antibiotic treatment and repeated operations could be required. In worst cases, some patients may have to undergo amputation. Recently, the usefulness of the Masquelet technique in extensive traumatic bone defects has been reported. We herein describe two cases of immunocompromised patients with purulent osteitis involving joint destruction of the finger treated by two-stage arthrodesis using the Masquelet technique. They obtained good infection control and better function of the finger than before the operation. Moreover, there was no recurrence of the infection. The Masquelet technique could be an alternative technique for osteitis with high risk of amputation.
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