Application of the induced membrane technique of tibia using extracorporeal vs. intracorporeal formation of a cement spacer: a retrospective study.

BACKGROUND: There were two ways of preparing the cement spacer: intracorporeal and extracorporeal formation. This study aimed to investigate the outcomes of extracorporeal vs. intracorporeal formation of a spacer using the induced membrane technique (IMT) for repairing bone defects of the tibia. METHODS: Sixty-eight patients with tibial defects treated with IMT were analyzed retrospectively. According to the mode of bone cement preparation, patients were divided into intracorporeal and extracorporeal groups (36 vs. 32 respectively). All patients were followed up for 12-48 months (average 18.7 months). The time interval between the first and second stages, the time required to remove the spacer, injury of the IM or bone ends, bone healing and infection control, as well as the functional recovery (Johner-Wruhs scoring), were compared. RESULTS: There was no significant difference in the preoperative data between the two groups (P > 0.05). There was no significant difference in the time interval (12.64 ± 4.41vs. 13.22 ± 4.96 weeks), infection control (26/28 vs. 20/23), bone healing time (7.47 ± 2.13vs. 7.50 ± 2.14 mos), delayed union (2/36 vs. 2/32), nonunion (2/36 vs. 1/32), an excellent or good rate of limb functional recovery (30/36 vs. 26/32) between the intracorporeal and extracorporeal groups (P > 0.05). However, the time required to remove (3.97 ± 2.34 min) was longer and the injury of IM or bone ends (28/36) was greater in the intracorporeal group than those in the extracorporeal group (0.56 ± 0.38 min and 1/32, respectively), showing a significant difference (P < 0.05). CONCLUSION: Both approaches were shown to have similar effects on bone defect repair and infection control. However, intracorporeal formation had advantages in terms of additional stability, while extracorporeal formation had advantages in terms of removal. Therefore, the specific method should be selected according to specific clinical needs. We recommended the extracorporeal or the modified extracorporeal formation in most cases.

Bone defects are repaired by enhanced osteogenic activity of the induced membrane: a case report and literature review.

BACKGROUND: The induced membrane technique (IMT) is an effective strategy to repair bone defects and involves a two-stage set of surgical procedures. Although the IM has osteogenic activity, bone grafting is necessary in standard IMT. Bone defects repaired completely by osteogenic activity of the IM alone without bone grafts are rare. CASE PRESENTATION: We present a case of infected fractures and bone defects of the ulna and radius treated with IMT. After the first stage using polymethylmethacrylate (PMMA) beads, X-rays showed that new callus developed after 2 to 4 months, and the defects were repaired completely by 5 months. We also present a literature review on spontaneous osteogenesis of the IM in patients. CONCLUSIONS: We present a case of infected ulnar and radial bone defects that healed by 5 months after the first stage of the IMT using a PMMA spacer. This finding suggests that local associated inflammatory reactions and bone tissue might enhance the osteogenic activity of the IM, causing spontaneous healing of bone defects. This appears to be the first such case reported in the literature.

Induced membrane technique in the treatment of infectious bone defect: A clinical analysis.

BACKGROUND: At present, it is still a challenge for repairing a wide range of bone defect caused by various reasons. We aimed to investigate the effect of induced membrane technique in the treatment of infectious bone defect. PATIENTS AND METHODS: The clinical data of twenty-one patients with infectious bone defect that received induced membrane technique treatment from January 2008 to August 2017 were collected for this study. The complications were recorded, and the bone defect healing and the recovery of joint function were evaluated by Paley method. The adjacent joint activities were also evaluated. RESULTS: One month after the first stage of surgery, one case had wound dehiscence, and others healed well without infection. Six cases had induced membrane injury during the second stage of surgery, and 4 of them received induced membrane wrapping reconstruction. At the last follow-up, bone defect healing was excellent, the joint function was restored (the rate of excellent and good was 90.5%). The joint range of motion recovered well and the rate of excellent and good was 81.0%. CONCLUSION: Induction membrane technique in the treatment of infectious bone defect has advantages of simple operation, rapid healing of bone defects, and low recurrence rate of infection.

[EFFECTIVENESS OF SHARP TEETH HOOK PLATE FOR TREATMENT OF OLECRANON FRACTURES].

OBJECTIVE: To investigate the effectiveness of sharp teeth hook plate by cutting for the treatment of olecranon fractures by comparison with Kirschner wire tension belt and locking plate. METHODS: Between January 2011 and April 2015, 32 cases of olecranon fractures were treated. Fracture was fixed with sharp teeth hook plate by cutting in 12 cases (trial group) and with Kirschner wire tension belt or locking plate in 20 cases (control group). There was no significant difference in gender, age, side and type of fracture, and time from injury to operation between 2 groups (P>0.05). The healing time of fractures and complications were recorded. At 1 year after operation, the subjective function results were evaluated according to Disability of Arm, Shoulder, and Hand (DASH) score, and objective function results by Mayo Elbow Score (MEPS); visual analogue scale (VAS) was used for elbow joint pain, and range of motion of flexion and extension of elbow joint was measured. RESULTS: All incisions healed by first intention, with no vascular and nerve injuries. All patients were followed up 12-36 months with an average of 18 months. All fractures healed, and there was no significant difference in the healing time between 2 groups (P>0.05). Loosening of Kirschner wire occurred in 2 cases of control group, but no loosening of internal fixation was observed in trial group after operation. There was no significant difference in the incidence of complications between 2 groups (P>0.05). The DASH, MEPS, VAS score, and range of motion of flexion in trial group were superior to those in control group, showing significant differences (P<0.05) at 1 year after operation. There was no significant difference in range of motion of extension between 2 groups (P>0.05). CONCLUSIONS: Sharp teeth hook plate for treatment of olecranon fractures overcomes the shortcomings that Kirschner wire tension is easy to slide and locking plate has a compression effect on triceps tendon, so it has good effectiveness.

[A COMPARATIVE STUDY ON TREATMENT OF MID-THORACIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE USING PERCUTANEOUS KYPHOPLASTY WITH UNILATERAL AND BILATERAL APPROACHES].

OBJECTIVE: To compare the effectiveness of percutaneous kyphoplasty (PKP) between by unilateral approach and by bilateral approaches for treating mid-thoracic osteoporotic vertebral compression fracture (OVCF). METHODS: A prospective randomized controlled study was performed on 22 patients with mid-thoracic OVCF between September 2012 and June 2014. PKP was performed by unilateral approach in 11 cases (group A) and by bilateral approaches in 11 cases (group B). There was no significant difference in gender, age, causes of injury, disease duration, affected segment, preoperative bone mineral density, Cobb angle, compression rate of the anterior verterbral height, and Visual analogue scale (VAS) score between 2 groups (P > 0.05). The operation time, perspective times, hospitalization expenses, the leakage of cement, the sagittal Cobb angle, compression rate of the anterior vertebral height, and VAS scores were compared between 2 groups. RESULTS: The operation time, perspective times, and hospitalization expenses of group A were significantly less than those of group B (P < 0.05). Twenty-two patients were followed up 13-34 months (mean, 15.3 months). Primary healing of incision was obtained in all patients, and no early complication of cement leakage, hypostatic pneumonia, or deep vein thrombosis occurred. At last follow-up, no new fracture occurred at the adjacent segments. The Cobb angle, compression rate of anterior verterbral height, and VAS score at 1 week and last follow-up were significantly improved when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between at 1 week and at last follow-up (P > 0.05). There was no significant difference in Cobb angle, compression rate of the anterior vertebral height, and VAS score between 2 groups at each time point (P > 0.05). CONCLUSION: PKP by both unilateral approach and bilateral approaches has the same effectiveness, but unilateral approach has shorter operation time, less perspective times, and less hospitalization expenses than bilateral approaches.

[INDUCED MEMBRANCE TECHNIQUE OF HOLLOW POROUS ANTIBIOTIC- IMPREGNATED BONE CEMENT FORMING IN VITRO AND LAVAGE IN VIVO FOR TREATMENT OF OSTEOMYELITIS].

OBJECTIVE: To explore the effectiveness of induced membrane technique of hollow porous antibiotic-impregnated bone cement forming in vitro and lavage in vivo for the treatment of osteomyelitis. METHODS: Between January 2010 and March 2014, 14 cases of osteomyelitis were treated by induced membrane technique of hollow porous antibiotic-impregnated bone cement forming in vitro and lavage in vivo after debridement at the first stage, then the bone cement with bone graft was replaced during the induced membrane after infection was controlled at the second stage. The time from first to second stage operation was 8-12 weeks (average, 10.2 weeks). There were 11 males and 3 females, aged 18 to 69 years (average, 39.2 years). According to Cierny-Mader classification of osteomyelitis, 2 cases were rated as intramedullary type, 5 cases as limited type, and 7 cases as diffusing type. The course of osteomyelitis was 3 months to 20 years, averaged 1.9 years. The healing of bone defect and the functionary recovery of adjacent joint were evaluated according to Paley's method. RESULTS Debridement was performed for two times in 1 case, and for one time in 13 cases for control of bone infection at the first stage. All incisions healed by first intention after second stage. All patients were followed up 15-48 months (average, 13.4 months), with no recurrence of infection. All bone defects healed, and the clinical healing time was 4-5 months (average, 4.4 months). The results of bone healing grade were excellent in all cases at 1 year after operation; the functional recovery of adjacent joint at last follow-up was excellent in 4 cases, good in 8 cases, and fair in 2 cases, and the excellent and good rate was 85.7%. CONCLUSION: Induced membrane technique of hollow porous antibiotic-impregnated bone cement forming in vitro and lavage in vivo for treatment of osteomyelitis has the advantages of high rate of elution of antibiotics, ease of lavage of medullary cavity, and no damage to induced membrane and bony interface between bone and bone cement when removing cement, it is effective for control of bone infection and repair of bone defect.

[Progress of Masquelet technique to repair bone defect].

OBJECTIVE: To summarize the progress of Masquelet technique to repair bone defect. METHODS: The recent literature concerning the application of Masquelet technique to repair bone defect was extensively reviewed and summarized. RESULTS: Masquelet technique involves a two-step procedure. First, bone cement is used to fill the bone defect after a thorough debridement, and an induced membrane structure surrounding the spacer formed; then the bone cement is removed after 6-8 weeks, and rich cancellous bone is implanted into the induced membrane. Massive cortical bone defect is repaired by new bone forming and consolidation. Experiments show that the induced membrane has vascular system and is also rich in vascular endothelial growth factor, transforming growth factor beta1, bone morphogenetic protein 2, and bone progenitor cells, so it has osteoinductive property; satisfactory results have been achieved in clinical application of almost all parts of defects, various types of bone defect and massive defect up to 25 cm long. Compared with other repair methods, Masquelet technique has the advantages of reliable effect, easy to operate, few complications, low requirements for recipient site, and wide application. CONCLUSION: Masquelet technique is an effective method to repair bone defect and is suitable for various types of bone defect, especially for bone defects caused by infection and tumor resection.