Masquelet technique for open tibia fractures in a military setting
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ORIGINAL ARTICLE
Masquelet technique for open tibia fractures in a military setting Laurent Mathieu1,2 · Emilie Bilichtin1 · Marjorie Durand3 · Nicolas de l’Escalopier1 · James Charles Murison1 · Jean‑Marc Collombet3 · Sylvain Rigal1,2 Received: 3 April 2019 / Accepted: 21 August 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
Abstract Purpose The induced membrane technique (IMT) is a two-stage procedure dedicated to reconstruction of bone defects of the limbs. The objective of this report was to evaluate employment of the IMT for the treatment of open tibia fractures managed in a military trauma center treating both wartime and peacetime injuries. Methods A retrospective study was performed among the patients treated via IMT for tibial bone defects related to open fractures between 2009 and 2018. The outcomes recorded included bone union, residual infection, amputation and lower limb function. Results During this period, 15 patients with a mean age of 39 years were included for the treatment of Gustilo II (2 cases) or Gustilo IIIB (13 cases) injuries. A mean number of 2.9 debridements were required before stage 1. Flap coverage was associated in 14 cases. The mean interval between stages was 22 weeks. Five patients were re-operated on after stage 1 due to persistent infection. The mean follow-up was 33 months. Bone union was achieved in 13 of the 15 cases (87%) at a mean time of 10.1 months. However, seven additional bone healing procedures were required, including six inter-tibiofibular grafting. Only one late septic recurrence was found. Most patients returned to work in sedentary jobs. Conclusions This series is the first to report IMT use in a military setting. The prior eradication of infection constitutes a major challenge in tibial bone defects, especially in high-energy, multi-tissue injuries. An inter-tibiofibular bone reconstruction approach is required when external fixation is chosen. Keywords Bone defect · Induced membrane technique · Infection · Masquelet technique · Military · Tibia
Introduction Among the various methods of bone reconstruction, the induced membrane technique (IMT), first described by Masquelet et al. [1] in 2000, has spread widely around the The views expressed in this paper are those of the authors and do not reflect the official policy or position of the French Army Health Medical Service. * Laurent Mathieu [email protected] 1
Clinic of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140 Clamart, France
2
Department of Surgery, French Medical Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005 Paris, France
3
Military Biomedical Research Institute, D19, 91220 Brétigny‑sur‑Orge, France
world in the last decade. Initially suggested for use in cases of bone loss resulting from tibial septic nonunion, indications for IMT have been extended to the management of any long bone segment, whatever the etiology of the bone defect [2, 3]. It is a two-stage procedure, im
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