Induced membrane technique with sequential internal fixation: use of a reinforced spacer for reconstruction of infected
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ORIGINAL PAPER
Induced membrane technique with sequential internal fixation: use of a reinforced spacer for reconstruction of infected bone defects Laurent Mathieu 1,2 & Léon Tossou-Odjo 1 & Nicolas de l’Escalopier 1 & Thomas Demoures 3 & Arnaud Baus 4 & Michel Brachet 4 & Alain Charles Masquelet 5 Received: 3 May 2020 / Accepted: 14 July 2020 # SICOT aisbl 2020
Abstract Purpose To evaluate a novel sequential internal fixation strategy using a reinforced spacer for infected bone defect reconstruction by the induced membrane technique (IMT). Methods A retrospective case study was performed among patients treated for infected bone defects by applying this strategy. Following radical debridement, temporary stabilization was provided by a massive cement spacer combined with minimal intramedullary fixation during step 1. Definitive internal fixation was performed together with bone grafting at step 2. Results Eight patients with a mean age of 58 years were reviewed. The mean bone defect length was 8.8 cm. The spacer armature mostly consisted of elastic nails and Steinmann pins. Iterative debridement was required in one case after step 1. The mean interval between steps was 12 weeks. Definitive internal fixation was performed by intramedullary nailing (n = 4) or plating (n = 4). At a mean follow-up of 21 months, bone union was achieved in seven cases without additional bone grafting or infection recurrence. Conclusions Sequential internal fixation using a reinforced cement spacer seems to be a valuable option for avoiding external fixation between IMT steps and limiting the recurrence of infection. Keywords Bone defect . Induced membrane technique . Masquelet technique . Post-traumatic osteomyelitis
Background The induced membrane technique (IMT) is an efficient method for reconstruction of infected bone defects under condition of a prior infection eradication [1–4]. Many authors have * Laurent Mathieu [email protected] 1
Clinic of Orthopedics, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
2
Department of surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 place Alphonse Laveran, 75005 Paris, France
3
Clinic of Orthopedics and Traumatology, Bégin Military Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France
4
Clinic of Esthetic and Reconstructive Surgery, Percy Military Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
5
Clinic of Orthopedics, Trauma and Hand Surgery, Saint-Antoine Hospital, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France
stressed that radical debridement of all contaminated and infected tissue is crucial before IMT application [3, 5–8]. In fact, it is sometimes difficult to differentiate the infected and nonviable tissues from healthy tissues in a single debridement, especially in cases of high-energy, multi-tissue trauma. Such injuries often require serial debridement before the cement spacer can be inserted into the bone defect [8, 9]. If necessary, an additional debridement should
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