HAL will be down for maintenance from Friday, June 10 at 4pm through Monday, June 13 at 9am. More information
Skip to Main content Skip to Navigation
Journal articles

Management of septic non-union of the tibia by the induced membrane technique. What factors could improve results?

Abstract : Introduction: Management of septic non-union of the tibia requires debridement and excision of allinfected bone and soft tissues. Various surgical techniques have been described to fill the bone defect.The “Induced Membrane” technique, described by A. C. Masquelet in 1986, is a two-step procedure usinga PMMA cement spacer around which an induced membrane develops, to be used in the second step as abone graft holder for the bone graft. The purpose of this study was to assess our clinical and radiologicalresults with this technique in a series managed in our department.Material and method: Nineteen traumatic septic non-unions of the tibia were included in a retrospectivesingle-center study between November 2007 and November 2014. All patients were followed up clinicallyand radiologically to assess bone union time. Multivariate analysis was used to identify factors influencingunion.Results: The series comprised 4 women and 14 men (19 legs); mean age was 53.9 years. Vascularized flaptransfer was required in 26% of cases before the first stage of treatment. All patients underwent a two-step procedure, with a mean interval of 7.9 weeks. Mean bone defect after the first step was 52.4 mm. Thebone graft was harvested from the iliac crest in the majority of cases (18/19). The bone was stabilized withan external fixator, locking plate or plaster cast after the second step. Mean follow-up was 34 months.Bony union rate was 89% (17/19), at a mean 16 months after step 2. Eleven patients underwent one ormore (mean 2.1) complementary procedures. Severity of index fracture skin opening was significantlycorrelated with union time (Gustilo III vs. Gustilo I or II, p = 0.028). A trend was found for negative impactof smoking on union (p = 0.06). Bone defect size did not correlate with union rate or time.Discussion: The union rate was acceptable, at 89%, but with longer union time than reported in theliterature. Many factors could explain this: lack of rigid fixation after step 2 (in case of plaster cast orexternal fixator), or failure to cease smoking. The results showed that the induced membrane techniqueis effective in treating tibial septic non-union, but could be improved by stable fixation after the secondstep and by cessation of smoking.
Document type :
Journal articles
Complete list of metadata

Contributor : Valerian Dormoy Connect in order to contact the contributor
Submitted on : Thursday, January 23, 2020 - 12:10:45 PM
Last modification on : Tuesday, March 1, 2022 - 7:30:07 PM

Links full text




Renaud Siboni, Etienne Joseph, Laurent Blasco, Coralie Barbe, Odile Bajolet, et al.. Management of septic non-union of the tibia by the induced membrane technique. What factors could improve results?. Orthopaedics and Traumatology - Surgery and Research, Elsevier, 2018, 104 (6), pp.911-915. ⟨10.1016/j.otsr.2018.04.013⟩. ⟨hal-02451496⟩



Record views