Article

A prospective study is reported concerning 11 cases of bone defect of the hand
and wrist treated by the induced membrane technique.
Ten men and one woman with
an average age of 49 yrs (17-72) sustained a high-energy trauma with severe
mutilation of digit and hand but with intact pulp. Eight cases of open finger
fractures with composite loss of substance and three cases of bone and joint
infection (thumb, wrist, fifth finger) were included. All cases were treated by
the induced membrane technique which consists in stable fixation, flap if
necessary, and in filling the bone defect by a cement methyl methacrylate
polymere (PMMA) spacer. A secondary procedure at two months is needed where the
cement is removed and the void is filled by cancellous bone. The key point of
this induced membrane technique is to respect the foreign body membrane which
formed around the cement spacer creating a biologic chamber. Bone union was
evaluated prospectively by X-ray and CT scan by a surgeon not involved in the
treatment. Failure was defined as non-union at one year, or uncontrolled sepsis
at one month. Two cases failed to achieve bone union. No septic complications
occurred and all septic cases were controlled. In nine cases, bone union was
achieved within four months (three to 12). Evidence of osteoid formation was
determined by a bone biopsy in one case. Masquelet first reported 35 cases of
large tibial non-union defects treated by the induced membrane technique. The
cement spacer promotes foreign body membrane induction constituting a biological
chamber. Works on animal models reported by Pellissier and Viateau demonstrated
membrane properties: secretion of growths factors (VEGF, TGF beta1, BMP2) and
osteoinductive cellular activity. The induced membrane seems to mimic a
neoperiosteum. This technique is useful in emergency or septic conditions where
bone defects cannot be treated by shortening. It avoids microsurgery and is
limited by availability of cancellous bone.
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Langue : FRANCAIS