Induced membrane technique for aseptic recalcitrant nonunion of the femur and tibia: Bone union and deformity correction outcomes

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-02-01 DOI:10.1016/j.jcot.2024.102879

Germán Garabano , Andres Juri , Renan Issac Guerrero Alvarado , Lucrecia Vena , Cesar Angel Pesciallo , Rafael Amadei Enghelmayer

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引用次数: 0

Abstract

Introduction

Aseptic recalcitrant nonunion (ARNU) of the femur and tibia is an entity in which the absence of bony union, misalignment, and limb length discrepancies (LLD) coexist. Currently, the management of these cases lacks consensus. This study aimed to describe the bone union rate and deformity correction outcomes in patients with ARNU of the femur or tibia treated with the Induced Membrane Technique (IMT).

Methods

We retrospectively review ten consecutive patients with ARNU (eight femoral and two tibial) treated with IMT in two stages, between January 2021 and May 2023, at a single center. The median age was 47.6 years (range 28–67), with an average of 2.76 previous surgeries (range 2–5). Six were atrophic, and four were eutrophic nonunions. All had LLD ranging from 11 to 35 mm (median 23.9), with coronal or sagittal plane misalignment between 10 and 15° (median 11.8) in six cases and rotational misalignments between 10 and 30° (median 17.5) in six cases, assessed by lower limb scanograph and rotations by computed tomography (CT) scan.

Results

The median bone defect length was 43 mm (range 30–60). Treatment involved a traction table in five cases, manual traction in three, and a femoral distractor in two. Fixation in the first stage included eight intramedullary nails and two locked plates. In the second stage, we filled the defect with autograft in eight cases and mixed (auto-allograft) in two (1:1 ratio). At the end of the follow-up, 9/10 patients showed bone union (seven without additional surgeries). There was one failure due to graft resorption. LLD was wholly corrected in four cases; the remaining six had a median discrepancy of 8.16 mm (range 2–15). No patients had axial or rotational misalignment exceeding 5°.

Conclusion

The results of this study suggest that IMT is viable for complex cases such as ARNU. Manipulating the defect allowed us to achieve an acceptable bone union rate, correcting length discrepancies up to 35 mm, axial misalignment up to 15°, and rotational misalignment up to 30°.

查看原文本刊更多论文

诱导膜技术治疗股骨和胫骨无菌性顽固性骨不连：骨愈合和畸形矫正的结果。

摘要：股骨和胫骨的无菌性顽固性骨不连（ARNU）是指骨不连、骨错位和肢体长度差异（LLD）并存的一种情况。目前，对这些病例的处理缺乏共识。本研究旨在描述采用诱导膜技术（IMT）治疗股骨或胫骨ARNU患者的骨愈合率和畸形矫正结果。方法：我们回顾性回顾了在2021年1月至2023年5月期间，在单一中心连续接受IMT治疗的10例ARNU患者（8例股骨和2例胫骨）。中位年龄47.6岁（28-67岁），平均2.76次手术（2-5岁）。6例萎缩性骨不连，4例富营养化骨不连。所有患者的LLD范围为11至35 mm（中位23.9），冠状面或矢状面偏差在6例中为10至15°（中位11.8），旋转偏差在6例中为10至30°（中位17.5），通过下肢扫描和计算机断层扫描（CT）旋转来评估。结果：骨缺损中位长度为43 mm（范围30 ~ 60）。治疗包括5例牵引台，3例手动牵引，2例股牵引器。第一阶段的固定包括8枚髓内钉和2枚锁定钢板。在第二阶段，我们用自体移植物填充缺损8例，混合（自体异体移植物）2例（1:1比例）。随访结束时，9/10患者骨愈合（7例未进行额外手术）。一例因移植物吸收而失败。4例LLD完全矫正；其余6例的中位差异为8.16 mm（范围2-15）。没有患者轴向或旋转不对准超过5°。结论：本研究结果提示IMT治疗ARNU等复杂病例是可行的。控制缺损使我们获得了可接受的骨愈合率，矫正长度差异达35毫米，轴向错位达15°，旋转错位达30°。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.