Simultaneous induced membrane technique to reconstruct an obliterated floating knee

Abstract

The induced membrane technique, first described by Masquelet, is a powerful surgical approach that can be used to address segmental bone loss of various aetiologies. Despite ongoing debate regarding optimal delivery, the indications and limits of its application have been tested in increasingly complex situations, highlighting its considerable potential. We present a case of a devastating open lower limb injury with simultaneous femoral and ipsilateral tibial bone loss including articular injury on both sides of the joint. The Masquelet technique was used to successfully address both segments of bone loss within the same limb.

Keywords: Bone defect; Floating knee; Induced membrane technique; Limb reconstruction; Masquelet.

Fig. 1

Coronal (left) and sagittal (right) slices of obliterated floating knee injury.

Fig. 2

Intra-operative clinical photographs after emergent debridement.

Fig. 3

Intra-operative radiographs following initial debridement and temporary fixation using external fixator, Kirschner wires and knee spanning intra-medullary wires. Top left: AP proximal tibia bottom left: AP tibial-femoral joint top right: AP distal femur bottom right: lateral tibial-femoral joint.

Fig. 4

Plain radiographs showing progression of consolidation in the femoral and tibial segments. (From left to right) radiographs at 1, 3 and 6 months. (Far right) sagittal CT section showing narrow regenerate column in the femoral segment.