Humeral atrophic pseudoarthrosis treated by Masquelet technique with non-vascularized fibular autograft
Keywords:
atrophic pseudoarthrosis, Masquelet technique, non-vascularized fibular autograft.Abstract
Introduction: Atrophic pseudarthrosis of the humeral diaphysis is a secondary bone defect and one of the most complex infrequent pathologies in Orthopedics, therefore, solving it is a challenge for specialists.
Objective: To demonstrate that the Masquelet technique with non-vascularized fibular autograft is efficient in the repair of large bone defects, specifically in humeral atrophic pseudarthrosis.
Case report: A 35-year-old patient with right humeral diaphysis fracture of the dominant limb is reported. She was operated on by open reduction and internal fixation; an atrophic pseudarthrosis of the humeral diaphysis was diagnosed and the Masquelet technique was applied with non-vascularized fibular autograft and bilateral iliac crest cancellous graft. Consolidation was achieved with good clinical and radiological results.
Conclusions: The treatment of humeral atrophic pseudarthrosis using the Masquelet technique with non-vascularized fibular autograft and bilateral iliac crest cancellous graft is an efficient method due to its radiological clinical result, minimal morbidity and low economic cost.
Downloads
References
El-Hadidi T, Soliman H, Farouk H, El-Mogeeb M. Staged bone grafting for the management of segmental long bone defects caused by trauma or infection using induced-membrane technique. Acta Orthop. Belg. 2018 [acceso 05/07/2021];84:384-96. Disponible en: http://www.actaorthopaedica.be/assets/3/02-El-Hadidi.pdf
Vejarano J, Ruiz C, Ganoza C, Hurtado J. Reconstrucción de defectos óseos segmentarios postraumáticos mediante técnica de inducción de membrana. Rev Med Hered. 2015;26(2):76-86. DOI: https://doi.org/10.20453/rmh.v26i2.2443
Ferreira N, Tanwar Y. Systematic approach to the management of post-traumatic segmental diaphyseal long bone defects: Treatment algorithm and comprehensive classification system. Strategies in Trauma and Limb Reconstruction. 2020;15(2):106-16. DOI: https://doi.org/10.505/jp-journals-10080-1466
Miska M, Findeisen S, Tanner M, Biglari B. Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept. Bone Joint J. 2016 [acceso 06/07/2021];98-B(1):81-7. Disponible en: https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620X.98B1.35682
Leiblein M, Verboket R, Marzi I, Wagner N, Nau C. Nonunions of the humerus. Treatment concepts and results of the last five years. Chinese Journal of Traumatology. 2019;22(4):187-95. DOI: https://doi.org/10.1016/j.cjtee.2019.04.002
Olson J, Entezari V, Vallier H. Risk factors for nonunion after traumatic humeral shaft fractures in adults. JSES Internacional. 2020;4:734-8. DOI: https://doi.org/10.1016/j.jseint.2020.06.009
O'Connor C, Perloff E, Drinane J, Cole K, Marinello P. An analysis of complications and bone defect length with the use of induced membrane technique in the upper limb: A Systematic Review. Hand (NY). 2020;17(3). DOI: https://doi.org/10.1177/1558944720918368
Niikura T, Jimbo N, Komatsu M, Oe K, Fukui T, Matsumoto T, et al. Histological analysis of induced membranes in patients whose bone defects were treated with the Masquelet technique to identify factors affecting the vascularity of induced membranes. Journal of Orthopaedic Surgery and Research. 2021;16:248. DOI: https://doi.org/10.1186/s13018-021-02404-7
Petrella G, Tosi D, Pantaleoni F, Adani R. Vascularized bone grafts for post-traumatic defects in the upper extremity. Arch Plast Surg. 2021;48:84-0. DOI: https://doi.org/10.5999/aps.2020.00969
Kashayi-Chowdojirao S, Vallurupalli A, Chilakamarri V, Patnala C, Chodavarapu L, Kancherla, et al. Role of autologous non-vascularised intramedullary fibular strut graft in humeral shaft nonunions following failed plating. Journal of clinical orthopaedics and trauma. 2017;8(Supl2):S21-S30. DOI: https://doi.org/10.1016/j.jcot.2016.12.006
Yadav S. The use of a free fibular strut as a “biological intramedullary nail” for the treatment of complex nonunion of long bones. JB&JS Open Access. 2018;3(2):e0050. DOI: https://doi.org/10.2106/JBJS.OA.17.00050
Singh S, Dawar H, Raina D, Rastogi S, Chaudhary N. Masquelet technique for treatment of post-traumatic bone defects. International Journal of Orthopaedics Sciences. 2020;6(2):694-0. DOI: https://doi.org/10.22271 / ortho.2020.v6.i2k.2122
Schmal H, Brix M, Bue M, Ekman A, Ferreira N, Gottlieb H, et al. Nonunion-consensus from the 4th annual meeting of the Danish Orthopaedic Trauma Society. EFORT Open Rev. 2020;5:46-57. DOI: https://doi.org/10.1302/2058-5241.5.190037
Ekinci Y, Gürbüz K. Is non-vascularized fibular grafting an effective choice in the treatment of the upper extremity pseudarthrosis? Erciyes Med J. 2020;42(2):167-73. DOI: http://dx.doi.org/10.14744/etd.2019.80148
Fung B, Hoit G, Schemitsch E, Godbout C, Nauth A. The induced membrane technique for the management of long bone defects. Bone Joint J. 2020;102-B(12):1723-34. DOI: https://doi.org/10.1302/0301-620X.102B12.BJJ-2020-1125.R1
Masquelet A, Kanakaris N, Obert L, Stafford, P, Giannoudis P. Bone repair using the Masquelet technique. J Bone Joint Surg Am. 2019;101(11):1024–36. DOI: http://dx.doi.org/10.2106/JBJS.18.00842
Lashin A, Mousa W, Hosni M, El-forse E. Induced membrane (Masquelet) technique for treatment of long bone defects. Med J Cairo Univ. 2018 [acceso 11/07/2021];86(1):215-22. Disponible en: https://mjcu.journals.ekb.eg/article_55079_7386881827353e909153ab7c78ef4c68.pdf
Hoit G, Kain M, Sparkman J, Norris B, Conway J, Watson J, et al. The induced membrane technique for bone defects: Basic science, clinical evidence, and technical tips, OTA International. 2021;4(2S):e106. DOI: https://doi.org/10.2106/JBJS.RVW.20.00206
Alford A, Nicolaou D, Hake M, McBride-Gagyi S. Masquelet's induced membrane technique: Review of current concepts and future directions. J Orthop Res. 2021;39:707-18. DOI: https://doi.org/10.1002/jor.24978
Maraskolhe D, Bhalotia A, Jaiswal P. Complications of fibular bone grafting at donor site. International Journal of Orthopaedics Sciences. 2018;4(2):482-4. DOI: https://doi.org/10.22271/ortho.2018.v4.i2h.73
Ebraheim N, Elgafy H, Xu R. Bone-graft harvesting from iliac and fibular donor sites: techniques and complications. J Am Acad Orthop Surg. 2001 [acceso 14/07/2021];9(3):210-8. Disponible en: https://journals.lww.com/jaaos/fulltext/2001/05000/bone_graft_harvesting_from_iliac_and_fibular_donor.7.aspx
Liu S, Tao S, Tan J, Hu X, Liu H, Li Z. Long-term follow-up of fibular graft for the reconstruction of bone defects. Medicine. 2018;97(40):e12605. DOI: https://doi.org/10.1097/MD.0000000000012605
Azi M, Aprato A, Santi I, Kfuri M, Masse A, Joeris A. Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2016;(17):465. DOI: https://doi.org/10.1186/s12891-016-1312-4
