Purpose
The Masquelet technique is a procedure increasingly utilized for addressing segmental
bone defects. The technique involves staged procedures consisting of bone debridement
and temporary spacer placement to induce membrane formation, followed by delayed bone
grafting. This report summarizes our center’s experience with the Masquelet technique
to reconstruct bone loss exclusively in the forearm.
Methods
We reviewed all cases in which the Masquelet technique was used to reconstruct segmental
bone defects in the forearm resulting from acute trauma or nonunion, with or without
infection, between 2014 and 2017 at a level-1 trauma center. Injury mechanism, prior
surgeries, extent of bone defect, and demographic data were collected. Union was assessed
along with treatment-related complications or reoperations.
Results
We identified 9 patients with segmental bony defects in the forearm treated with the
Masquelet technique. Among this cohort, 5 patients had bone defects associated with
acute open fractures and 4 patients presented with nonunion (1 atrophic and 3 infected
nonunions). The median bony defect was 4.7 cm (range, 1.7–5.4 cm) at the time of grafting.
Second stage grafting was performed with Reamer Irrigator Aspirator autograft from
the femur in 8 patients and iliac crest bone cancellous graft in 1 patient. Union
was achieved in all 9 patients. Six patients achieved union by 3-month follow-up,
2 patients by 6 months, and 1 patient by 12 months. One patient required a reoperation
for plate fracture prior to union treated with revision internal fixation and grafting.
Conclusions
The Masquelet technique effectively reconstructed traumatic and posttraumatic segmental
defects in the forearm with a low incidence of complication.
Type of study/level of evidence
Therapeutic V.
Key words
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References
- Functional outcomes of compression plating and bone grafting for operative treatment of nonunions about the forearm.J Hand Surg Am. 2018; 43: 564.e1-564.e9
- Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting.J Bone Joint Surg Am. 2004; 86-A: 2440-2445
- Bone grafts: a radiologic, histologic, and biomechanical model comparing autografts, allografts, and free vascularized bone grafts.Plast Reconstr Surg. 1984; 74: 368-379
- Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes.Injury. 2016; 47: S53-S61
- Masquelet technique for treatment of posttraumatic bone defects.ScientificWorldJournal. 2014; 2014: 710302
- Treatment of infected forearm nonunions with large complete segmental defects using bulk allograft and intramedullary fixation.J Hand Surg Am. 2016; 41: 881-887
- Reconstruction of the long bones by the induced membrane and spongy autograft.Ann Chir Plast Esthet. 2000; 45 ([in French]): 346-353
- Functional and radiographic evaluation of the treatment of traumatic bone loss of the hand using the Masquelet technique.Hand Surg Rehabil. 2016; 35: 114-121
- Early resection of congenital pseudarthrosis of the tibia and successful reconstruction using the Masquelet technique.J Bone Joint Surg Br. 2011; 93: 552-554
- Treatment of posttraumatic bone defects by the induced membrane technique.Orthop Traumatol Surg Res. 2012; 98: 97-102
- Masquelet technique for the treatment of a severe acute tibial bone loss.Injury. 2014; 45: S111-S115
- Management of recalcitrant osteomyelitis and segmental bone loss of the forearm with the Masquelet technique.J Hand Surg Eur Vol. 2017; 42: 640-642
- Masquelet technique for treatment of segmental bone loss in the upper extremity.J Hand Surg Am. 2015; 40: 593-598
- Use of the induced membrane technique for the treatment of bone defects in the hand or wrist, in emergency.Chir Main. 2010; 29 ([in French]): 307-314
- Aseptic forearm non-unions treated by plate and opposite fibular autograft strut.Clin Orthop Relat Res. 2009; 467: 2125-2134
- Massive bone defects of the upper limb: reconstruction by vascularized bone transfer.Hand Clin. 2007; 23: 49-56
- Free vascularized fibula for the treatment of traumatic bone defects and non-union of the forearm bones.J Hand Surg Br. 2005; 30: 67-72
- Bone transport for the treatment of infected forearm non-union.Injury. 2014; 45: 1880-1884
- Skeletal defects. A comparison of bone grafting and bone transport for segmental skeletal defects.Clin Orthop Relat Res. 1994; 301: 111-117
- Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration.J Orthop Res. 2004; 22: 73-79
- Osteoclasts and their precursors are present in the induced-membrane during bone reconstruction using the Masquelet technique.J Tissue Eng Regen Med. 2017; 11: 382-389
- Quantitative assessment of growth factors in reaming aspirate, iliac crest, and platelet preparation.Bone. 2006; 39: 1156-1163
- Reamer-irrigator-aspirator bone graft and bi-Masquelet technique for segmental bone defect nonunions: a review of 25 cases.Injury. 2010; 41: S72-S77
- The concept of induced membrane for reconstruction of long bone defects.Orthop Clin North Am. 2010; 41: 27-37
- Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing.Orthop Traumatol Surg Res. 2010; 96: 549-553
Article info
Publication history
Published online: August 23, 2018
Accepted:
July 13,
2018
Received:
November 12,
2017
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2019 by the American Society for Surgery of the Hand. All rights reserved.
