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Masquelet technique for open tibia fractures in a military setting

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The induced membrane technique (IMT) is a two-stage procedure dedicated to reconstruction of bone defects of the limbs. The objective of this report was to evaluate employment of the IMT for the treatment of open tibia fractures managed in a military trauma center treating both wartime and peacetime injuries.

Methods

A retrospective study was performed among the patients treated via IMT for tibial bone defects related to open fractures between 2009 and 2018. The outcomes recorded included bone union, residual infection, amputation and lower limb function.

Results

During this period, 15 patients with a mean age of 39 years were included for the treatment of Gustilo II (2 cases) or Gustilo IIIB (13 cases) injuries. A mean number of 2.9 debridements were required before stage 1. Flap coverage was associated in 14 cases. The mean interval between stages was 22 weeks. Five patients were re-operated on after stage 1 due to persistent infection. The mean follow-up was 33 months. Bone union was achieved in 13 of the 15 cases (87%) at a mean time of 10.1 months. However, seven additional bone healing procedures were required, including six inter-tibiofibular grafting. Only one late septic recurrence was found. Most patients returned to work in sedentary jobs.

Conclusions

This series is the first to report IMT use in a military setting. The prior eradication of infection constitutes a major challenge in tibial bone defects, especially in high-energy, multi-tissue injuries. An inter-tibiofibular bone reconstruction approach is required when external fixation is chosen.

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Acknowledgements

The authors thank all the surgeons, infectious disease specialists, bacteriologists and pharmacists who took part in the treatment of the patients.

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Authors and Affiliations

  1. Clinic of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France

    Laurent Mathieu, Emilie Bilichtin, Nicolas de l’Escalopier, James Charles Murison & Sylvain Rigal

  2. Department of Surgery, French Medical Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, 75005, Paris, France

    Laurent Mathieu & Sylvain Rigal

  3. Military Biomedical Research Institute, D19, 91220, Brétigny-sur-Orge, France

    Marjorie Durand & Jean-Marc Collombet

Authors
  1. Laurent Mathieu
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  2. Emilie Bilichtin
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  3. Marjorie Durand
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  4. Nicolas de l’Escalopier
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  5. James Charles Murison
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  6. Jean-Marc Collombet
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  7. Sylvain Rigal
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Correspondence to Laurent Mathieu.

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The authors declare that they have no conflict of interest, and no source of funding.

Additional information

The views expressed in this paper are those of the authors and do not reflect the official policy or position of the French Army Health Medical Service.

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Mathieu, L., Bilichtin, E., Durand, M. et al. Masquelet technique for open tibia fractures in a military setting. Eur J Trauma Emerg Surg 46, 1099–1105 (2020). https://doi.org/10.1007/s00068-019-01217-y

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  • DOI: https://doi.org/10.1007/s00068-019-01217-y

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