[Reconstruction of the long bones by the induced membrane and spongy autograft].
ABSTRACT In the reported series of 35 cases bone reconstruction of large diaphyseal defects was performed in two stages. The first stage was the insertion into the defect of a cement spacer which was responsible for the formation of a pseudosynovial membrane. The second stage was the reconstruction of the defect by a huge fresh autologous cancellous bone graft. The membrane induced by the spacer prevents the resorption of the graft and favors its vascularity and its corticalisation. In weight bearing diaphyseal segments the normal walking was possible at 8.5 months on average. The length of the reconstructed defects was 4 to 25 cm.
- SourceAvailable from: Frankie Leung[Show abstract] [Hide abstract]
ABSTRACT: Masquelet technique, which is the use of a temporary cement spacer followed by staged bone grafting, is a recent treatment strategy to manage a posttraumatic bone defect. This paper describes a series of 9 patients treated with this technique of staged bone grafting following placement of an antibiotic spacer to successfully manage osseous long bone defects. The injured limbs were stabilized and aligned at the time of initial spacer placement. In our series, osseous consolidation was successfully achieved in all cases. This technique gives promising result in the management of posttraumatic bone defects.The Scientific World Journal 01/2014; 2014:710302. · 1.73 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To evaluate the clinical and radiographic results associated with the use of a percutaneous supra-patellar (SP) portal and accompanying instrumentation for tibial intramedullary nail (IMN) insertion using a semi-extended approach. Prospective, non-randomized, non-consecutive study SETTING:: Level One Trauma Center METHODS:: From June 2007 to Jan 2011, 56 fractures (55 patients) underwent intramedullary nailing of a tibia fracture with a semi-extended approach through a SP portal. Radiographic and clinical follow-up examinations were performed at a minimum of one year post index procedure. Measurements included: bone healing, tibial alignment, knee ROM, pain drawings, pain scoring (VAS - Visual Analogue Scale), functional outcome (Lysholm and SF-36 scoring), evaluation of pre- and post- nail insertion arthroscopic images of the PF joint (subgroup of study patients), and one year follow-up MRI scans (STIR and T2 Gradient Echo) of the knee to evaluate the patella-femoral (PF) joint cartilage. MRI scans were reviewed by an independent bone radiologist, while arthroscopic images were evaluated by an independent sports medicine fellowship trained orthopaedic surgeon. 36 patients (37 fractures) were available for follow-up at a minimum of one year (range 12-49 months) after the index procedure. All but two fractures healed after the index procedure (94.6%). There was one radiographic mal-union (2.7%). The mean Lysholm knee score was 82.14. Mean SF-36 physical and mental scores, were 40.8 and 46.0 respectively. Mean arc of knee motion was 124.4 degrees for the affected extremity compared to 127.2 degrees for the contralateral knee. One patient (2.7%) complained of mild pain at the scar, but no patient complained of anterior knee pain either at the PF joint or anterior proximal tibia. In 13/15 patients undergoing an arthroscopic assessment of the PF joint pre- and post- nail insertion, no cartilage changes, or pressure points were seen either at the patella or trochlea groove. Two patients had grade II chondromalacia of the trochlea immediately post procedure, but these did not correspond with either MRI scans, or clinical findings at one year. When the remainder of the one year MRI scans were reviewed, one knee (2.7%) in a patient that did not have an arthroscopic exam, was found to have Grade II chondromalacia in the PF joint, but this did not correlate with the clinical exam, which was normal. This is the first paper to critically document clinical and radiographic results using the percutaneous SP portal with the semi-extended approach for IMN of the tibia. Our one year results indicate that the procedure resulted in excellent tibial alignment, union, and knee ROM, with rare sequelae in the PF joint based on immediate arthroscopy and one year MRI scans and clinical exams. Even more interesting was the absence of anterior tibial pain often found when a tibial nail is inserted in a standard fashion. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.Journal of orthopaedic trauma 04/2014; · 1.78 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The induced membrane has been widely used in the treatment of large bone defects but continues to be limited by a relatively lengthy healing process and a requisite two stage surgical procedure. Here we report the development and characterization of a synthetic biomimetic induced membrane (BIM) consisting of an inner highly pre-vascularized cell sheet and an outer osteogenic layer using cell sheet engineering. The pre-vascularized inner layer was formed by seeding human umbilical vein endothelial cells (HUVECs) on a cell sheet comprised of a layer of undifferentiated human bone marrow-derived mesenchymal stem cells (hMSCs). The outer osteogenic layer was formed by inducing osteogenic differentiation of hMSCs. In vitro results indicated the undifferentiated hMSCs cell sheet facilitated the alignment of HUVECs and significantly promoted the formation of vascular-like networks. Furthermore, seeded HUVECs rearranged the extracellular matrix produced by hMSCs sheet. After subcutaneously implantation, the composite constructs showed rapid vascularization and anastomosis with the host vascular system, forming functional blood vessels in vivo. Osteogenic potential of the BIM was evidenced by immunohistochemistry staining of osteocalcin, tartrate-resistant acid phosphatase (TRAP) staining, and alizarin red staining. In summary, the synthetic BIM showed rapid vascularization, significant anastomoses, and osteogenic potential in vivo. This synthetic BIM has the potential for treatment of large bone defects in the absence of infection.Bone 01/2014; · 3.82 Impact Factor