A load-sharing nail - cage construct may improve outcome after induced membrane technique for segmental tibial...

Area of Science:

• Orthopedic surgery
• Regenerative medicine
• Biomaterials

Background:

• The induced membrane technique (IMT) is a standard method for treating segmental bone defects.
• Variations of IMT exist, necessitating evaluation of specific constructs.
• Segmental tibial defects pose significant reconstructive challenges.

Purpose of the Study:

• To assess the radiological and functional outcomes of IMT using a nail-graft filled titanium cage for tibial defects.
• To evaluate the efficacy of this specific IMT construct in traumatic bone defects.

Main Methods:

• A two-stage IMT procedure was performed on 26 adult patients with moderate to large tibial defects.
• Stage 1 involved debridement and antibiotic cement spacer placement.
• Stage 2 utilized an intramedullary nail and a graft-filled titanium cage for reconstruction.

Main Results:

• Excluding 5 cases due to infection, 21 patients achieved 100% bone union.
• Mean time to painless weight-bearing was 26 days; return to work averaged 45 days.
• Mean Lower Extremity Functional Scale (LEFS) score was 67 at 27 months follow-up.

Conclusions:

• IMT with a nail-cage construct yields excellent union rates and functional restoration for tibial defects.
• Persistent infection is a primary barrier to successful IMT.
• The cage addition may enhance short-term function, including weight-bearing and return to work.