Effectiveness of the induced membrane technique in aseptic and infected long-bone defect management: Are there any differences?

Abstract

Management of post-traumatic long-bone defects remains relevant and challenging despite the rapid development of approaches to their treatment. Dominant positions are occupied by the Ilizarov method, bone autogenous grafting and the Masquelet induced membrane technique (IMT). The IMT is aimed at reducing extensive defect treatment duration and for this reason has gained great popularity. However, the assessment of its effectiveness is difficult due to a limited number of clinical series. The varying clinical manifestations of bone defect severity do not allow a comprehensive evaluation of IMT effectiveness. One of them is infection in the defect area. The purpose of our literature review is an analysis of studies on IMT application in infected vs non-infected long-bone defects of the lower extremities published over the last 10 years. It focuses on the investigation of similarities and fundamental differences in the need for antibiotics, timing of spacer fixation, methods of collecting donor bone and fixators used for consolidation. The studies show that the IMT has been globally used in aseptic and osteomyelitic defects due to its clinical effectiveness. Authors' variations and improvements in its practical implementation indicate the ongoing development and the interest of researchers in this technique.

Keywords: Defect; External fixator; Induced membrane technique; Infection; Intramedullary nail; Long bone; Nonunion; Osteomyelitis; Spacer.