Predictors of Reoperation in Induced Membrane Technique for Acute Traumatic Bone Loss

Abstract

Objectives: To identify patient, injury, and surgical characteristics associated with success or failure of Masquelet's induced membrane technique (IMT) for acute traumatic bone loss.

Methods: Design: Retrospective cohort study.

Setting: Four Level 1 Academic Trauma Centers.

Patients selection criteria: Patients acutely treated with IMT for AO/OTA 32, 33, and 41-43 fractures with bone loss at four Level 1 trauma centers between 2010-2020.

Outcome measure and comparisons: Primary outcome was fracture union with comparison between union after initial two stage IMT versus patients who underwent reoperation to promote union or experienced treatment failure defined as: amputation, implant dependent, or persistent nonunion. Variables of interest included demographic variables, injury characteristics, and differences in surgical management (definitive fixation construct, autograft source, use of graft adjuvants).

Results: 130 fractures with defects were treated with IMT, including 72 tibial fractures and 58 femoral fractures with an average defect length of 6.4cm. Average age of patients was 40 years (range 16 to 68 years) and 65 percent of patients were male. Demographic characteristics including age, sex, BMI, tobacco and alcohol use were not significantly different among treatment outcomes (p >.05). Initial success after two stage IMT was 57.7% (75/130) and 82% (107/130) after subsequent reoperation. Increasing defect length was associated with failure of IMT (mean 5.4 vs 8.3cm, p=.03). Deep infection after stage 2 surgery was associated with reoperation to promote union and treatment failure (p<.01).

Conclusions: In this study of acute traumatic bone loss, shorter defect length and absence of infection were significantly associated with success of IMT. Meanwhile fixation construct and autograft choice were not associated with treatment outcome.

Level of evidence: III retrospective comparative cohort series.

Keywords: Masquelet; critical bone loss; induced membrane; nonunion; traumatic osseous defect.