Induced Membrane Technique for the Management of Segmental Femoral Defects: A Systematic Review and Meta‐Analysis of Individual Participant Data

Several modifications of the induced membrane technique (IMT) have been reported, but there is no consensus regarding their results and prognosis. Moreover, most studies have focused on tibial defects; no meta‐analysis of the treatment of femoral defects using the IMT has been reported. This systematic review and meta‐analysis aimed to identify the potential risk factors of post‐procedural complications following the treatment of segmental femoral defects using the IMT. A comprehensive search was performed on the Cochrane Library, EBSCO, EMBASE, Ovid, PubMed, Scopus, and Web of Science databases, using the keywords “femur,” “Masquelet technique,” and “induced membrane technique.” Original articles composed in English, having accessible individual patient data, and reporting more than two cases of bony defect or nonunion of femur or more than five cases of any body part were included. Post‐procedural bone graft infections, final union status, and union time after second‐stage operation were analyzed. Fourteen reports, including 90 patients, were used in this study. External fixation in second‐stage surgery had an odds ratio of 9.267 for post‐procedural bone graft infection (p = 0.047). The odds ratio of post‐procedural bone graft infection and age >65 years for final non‐union status was 51.05 (p = 0.003) and 9.18 (p = 0.042). Shorter union time was related to impregnated antibiotics in the spacer (p = 0.005), transplanting all‐autologous grafts (p = 0.042), and the application of intramedullary nails as the second‐stage fixation method (p = 0.050). The IMT appears to be reasonable and reproducible for femoral segmental bone defects. Several preoperative and surgical factors may affect post‐procedural complications and union time.

[1]  K. Egol,et al.  Risk Factors for Gram-Negative Fracture-Related Infection. , 2022, Orthopedics.

[2]  G. Haidukewych,et al.  Retrograde intramedullary nailing of comminuted intra-articular distal femur fractures results in high union rate , 2021, European Journal of Orthopaedic Surgery & Traumatology.

[3]  G. Ernst,et al.  Masquelet technique in post-traumatic infected femoral and tibial segmental bone defects. Union and reoperation rates with high proportions (up to 64%) of allograft in the second stage. , 2021, Injury.

[4]  F. Duteille,et al.  Preliminary Results of the “Capasquelet” Technique for Managing Femoral Bone Defects—Combining a Masquelet Induced Membrane and Capanna Vascularized Fibula with an Allograft , 2021, Journal of personalized medicine.

[5]  L. Kopp,et al.  Management of bone defects using the Masquelet technique of induced membrane. , 2021, Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti.

[6]  Jun Liu,et al.  Masquelet technique for reconstructing bone defects in open lower limb fracture: Analysis of the relationship between bone defect and bone graft. , 2020, Injury.

[7]  P. Giannoudis,et al.  Induced Membrane Technique (Masquelet) for Bone Defects in the Distal Tibia, Foot, and Ankle: Systematic Review, Case Presentations, Tips, and Techniques. , 2020, Foot and ankle clinics.

[8]  E. Schemitsch,et al.  The induced membrane technique for the management of long bone defects. , 2020, The bone & joint journal.

[9]  A. Masquelet,et al.  Induced membrane technique: a critical literature analysis and proposal for a failure classification scheme , 2020, European Journal of Trauma and Emergency Surgery.

[10]  O. Barbier,et al.  Application of the Masquelet technique in austere environments: experience from a French forward surgical unit deployed in Chad , 2020, European Journal of Trauma and Emergency Surgery.

[11]  A. Masquelet,et al.  Induced membrane technique with sequential internal fixation: use of a reinforced spacer for reconstruction of infected bone defects , 2020, International Orthopaedics.

[12]  Keegan P Cole,et al.  An Analysis of Complications and Bone Defect Length With the Use of Induced Membrane Technique in the Upper Limb: A Systematic Review , 2020, Hand.

[13]  G. Ayouba,et al.  Interest of nailing associated with the Masquelet technique in reconstruction of bone defect. , 2020, Journal of orthopaedics.

[14]  Yi-Hsun Yu,et al.  The Induced Membrane Technique for the Management of Segmental Tibial Defect or Nonunion: A Systematic Review and Meta-Analysis , 2020, BioMed research international.

[15]  P. Giannoudis,et al.  Mixed results with the Masquelet technique: A fact or a myth? , 2019, Injury.

[16]  C. Tufanaru,et al.  Methodological quality of case series studies: an introduction to the JBI critical appraisal tool , 2019, JBI database of systematic reviews and implementation reports.

[17]  S. Findeisen,et al.  Does Age Influence the Outcome of Lower Limb Non-Union Treatment? A Matched Pair Analysis , 2019, Journal of clinical medicine.

[18]  R. Sanders,et al.  'Intramedullary Nails Yield Superior Results Compared to Plate Fixation when using the Masquelet Technique in the Femur and Tibia.' , 2019, Journal of orthopaedic trauma.

[19]  Ying-Chao Chou,et al.  Augmentative antirotational plating provided a significantly higher union rate than exchanging reamed nailing in treatment for femoral shaft aseptic atrophic nonunion - retrospective cohort study , 2019, BMC Musculoskeletal Disorders.

[20]  J. Watson,et al.  Masquelet technique: The effect of altering implant material and topography on membrane matrix composition, mechanical and barrier properties in a rat defect model. , 2018, Journal of biomechanics.

[21]  B. El-Alfy,et al.  The use of free nonvascularized fibular graft in the induced membrane technique to manage post-traumatic bone defects , 2018, European Journal of Orthopaedic Surgery & Traumatology.

[22]  L. Drago,et al.  Managing large bone defects in children: a systematic review of the ‘induced membrane technique’ , 2017, Journal of pediatric orthopedics. Part B.

[23]  A. Dossim,et al.  Reconstruction of traumatic bone loss using the induced membrane technique: preliminary results about 11 cases. , 2017, Journal of orthopaedics.

[24]  A. Shin,et al.  Vascularized Bone Grafts in Orthopaedic Surgery , 2017, JBJS reviews.

[25]  R. Steen,et al.  Bone fracture nonunion rate decreases with increasing age: A prospective inception cohort study. , 2017, Bone.

[26]  S. Morimoto,et al.  Induced membrane technique using beta-tricalcium phosphate for reconstruction of femoral and tibial segmental bone loss due to infection: technical tips and preliminary clinical results , 2017, International Orthopaedics.

[27]  Zhao Xie,et al.  Antibiotic cement-coated locking plate as a temporary internal fixator for femoral osteomyelitis defects , 2017, International Orthopaedics.

[28]  S. Pannier,et al.  Success rate and risk factors of failure of the induced membrane technique in children: a systematic review. , 2016, Injury.

[29]  L. Drago,et al.  Masquelet technique: myth or reality? A systematic review and meta-analysis. , 2016, Injury.

[30]  P. Giannoudis,et al.  Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes. , 2016, Injury.

[31]  C. Mauffrey,et al.  Reconstruction of Long Bone Infections Using the Induced Membrane Technique: Tips and Tricks , 2016, Journal of orthopaedic trauma.

[32]  L. Drago,et al.  Modeling Staphylococcus epidermidis-Induced Non-Unions: Subclinical and Clinical Evidence in Rats , 2016, PloS one.

[33]  S. Mehta,et al.  Biological Risk Factors for Nonunion of Bone Fracture , 2016, JBJS reviews.

[34]  A. Hede,et al.  The Masquelet technique of induced membrane for healing of bone defects. A review of 8 cases. , 2015, Injury.

[35]  Ayman M. Ali,et al.  Management of segmental skeletal defects by the induced membrane technique , 2015, Indian journal of orthopaedics.

[36]  Richard D Riley,et al.  Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data: The PRISMA-IPD Statement , 2015 .

[37]  Cyril Mauffrey,et al.  Management of Segmental Bone Defects , 2015, The Journal of the American Academy of Orthopaedic Surgeons.

[38]  K. Lampropoulou-Adamidou,et al.  Strategies for managing bone defects of the lower extremity. , 2014, Clinics in podiatric medicine and surgery.

[39]  W. Obremskey,et al.  Current Practice in the Management of Open Fractures Among Orthopaedic Trauma Surgeons. Part B: Management of Segmental Long Bone Defects. A Survey of Orthopaedic Trauma Association Members , 2014, Journal of orthopaedic trauma.

[40]  R. Karia,et al.  Older Age Does Not Affect Healing Time and Functional Outcomes After Fracture Nonunion Surgery , 2014, Geriatric orthopaedic surgery & rehabilitation.

[41]  M. Bumbasirevic,et al.  Free vascularised fibular grafts in orthopaedics , 2014, International Orthopaedics.

[42]  M. Bhandari,et al.  Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. , 2013, The bone & joint journal.

[43]  Allison E. Williams,et al.  Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients , 2013, Journal of Orthopaedic Surgery and Research.

[44]  P. Merloz,et al.  Bone transport techniques in posttraumatic bone defects. , 2012, Orthopaedics & traumatology, surgery & research : OTSR.

[45]  Derek J Donegan,et al.  Staged bone grafting following placement of an antibiotic spacer block for the management of segmental long bone defects. , 2011, Orthopedics.

[46]  B. Norris,et al.  Reamer-irrigator-aspirator bone graft and bi Masquelet technique for segmental bone defect nonunions: a review of 25 cases. , 2010, Injury.

[47]  P. Cronier,et al.  Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing. , 2010, Orthopaedics & traumatology, surgery & research : OTSR.

[48]  P. Giannoudis,et al.  Current management of long bone large segmental defects , 2010 .

[49]  H. Pape,et al.  Autologous Bone Graft: Properties and Techniques , 2010, Journal of orthopaedic trauma.

[50]  W. Ricci,et al.  Intramedullary Nailing of Femoral Shaft Fractures: Current Concepts , 2009, The Journal of the American Academy of Orthopaedic Surgeons.

[51]  M. Archdeacon,et al.  Avoiding complications in the care of fractures of the tibia. , 2008, The Journal of bone and joint surgery. American volume.

[52]  Z. Gugala,et al.  New Approaches in the Treatment of Critical‐Size Segmental Defects in Long Bones , 2007 .

[53]  A. Simpson,et al.  The management of fractures with bone loss. , 2005, The Journal of bone and joint surgery. British volume.

[54]  F. Fitoussi,et al.  [Reconstruction of the long bones by the induced membrane and spongy autograft]. , 2000, Annales de chirurgie plastique et esthetique.