Masquelet technique for open tibia fractures in a military setting.

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Regenerative Medicine

Background:

• The induced membrane technique (IMT) is a two-stage reconstructive procedure for bone defects.
• Open tibia fractures, particularly high-energy injuries, pose significant challenges in military settings.
• Effective management requires addressing bone defects, infection, and functional restoration.

Purpose of the Study:

• To evaluate the efficacy of the induced membrane technique (IMT) for treating open tibia fractures.
• To assess IMT outcomes in a military trauma center managing both wartime and peacetime injuries.
• To identify challenges and requirements for successful IMT application in complex tibial defects.

Main Methods:

• Retrospective study of 15 patients with open tibia fractures treated with IMT between 2009 and 2018.
• Data collection included bone union, infection rates, amputation, and functional outcomes.
• Analysis of debridement, flap coverage, interval between stages, and re-operations.

Main Results:

• 87% bone union achieved in 15 Gustilo II/IIIB open tibia fractures (mean follow-up 33 months).
• Mean of 2.9 debridements and 22 weeks between stages were required; 5 patients needed re-operation for infection.
• Seven additional bone healing procedures were necessary, including inter-tibiofibular grafting in six cases.

Conclusions:

• IMT is a viable option for reconstructing tibial bone defects in a military context.
• Eradicating infection is a critical challenge, especially in multi-tissue, high-energy injuries.
• Inter-tibiofibular bone reconstruction is often necessary when external fixation is employed.