The Masquelet Induced Membrane Technique for the Treatment of Large Bone Defects in High Energy GSW Injuries – The Soroka University Medical Center Experience

Background:
The Masquelet technique is a two-stage technique for reconstructing large bone defects. It was first described by Alain Masquelet in the 1980’s, and published in the year 2000. Since than its popularity is continuously growing with promising results being published worldwide. We will present our experience and results with the use of the Masquelet technique in the treatment of high energy open fractures.

Methods:
This is prospective cohort study, taking place at the Orthopedic department of the Soroka University Medical Center in Beer Sheva, Israel. We began utilizing the Masquelet technique in 2019, in combination with both intra-medullary nails and external fixators, mainly for non-union of high-energy open fractures. Data was prospectively collected regarding the nature of the injury, number of surgical procedures, infection rates, healing time, and complications.

Results:
Since January 2019, six patients were treated using the Masquelet technique at our department. They were all males, between the ages of 16-40, and had a bone defect averaging 10.5 cm. Their open fractures were all caused by high energy assault rifles, 4 with tibial fractures and 2 with mid-shaft femur fractures. All fractures had sterile cultures during the surgical interventions. Two patients were primarily treated using an IMN, two with a uni-planar External fixator and two with the Ilizarov ring fixator. The second stage was performed between 8-30 weeks, using bone graft taken from the iliac crest of the ipsilateral side. Weight bearing was initiated after 4 months in average. All 6 Patients were painless after 8 months, and achieved full bony union.

Conclusion:
Staged reconstruction of large bone defects with the use of the Induced Membrane technique (Masquelet) resulted in a high union rate.