|
|
|
« Back
New Technique to Treat Bone Fractures with Significant Bone Loss
|
Posted on: 04/26/2012
|
Sometimes bone fractures are so severe the bones of the arm or leg can't just be lined up, put in a cast, and heal on their own. Bones that are broken into several (or even many) pieces with space between the pieces create a condition called segmental bone loss.
When this happens, the surgeon is faced with a very complex and complicated surgical situation. And the patient often endures multiple surgical procedures, delays in healing, and a very long recovery time. In the worst case scenario, the patient goes through all that only to end up having the foot or hand, arm or leg amputated.
Now a new two-stage surgical procedure has been introduced with good early success that may change all that. It's called the induced membrane technique for bone reconstruction. In the first step, a temporary spacer is placed in the area of bone loss.
The implanted device is called a polymethylmethacrylate (PMMA) spacer. PMMA is a type of cement that helps hold everything together. The spacer is "bioactive" meaning it will stimulate bone growth. An antibiotic is also mixed in with the cement to help prevent infection. In the second stage, the membrane is filled with allograft bone graft material taken from a bone graft (allograft means it is donor tissue from a bone bank).
In this article, surgeons from the well-known Mount Carmel Medical Center in Ohio present several cases using the induced membrane technique. Using preoperative and intraoperative photos along with X-rays, they describe and show the way the procedure is done and the results afterwards.
Before the spacer can be put in place, the surgeon debrides (cleans out and removes) all dead or infected tissue. This preparatory step helps reduce the risk of infection and loss of tissue later. Along with the spacer to restore normal bone length, hardware (metal rods, plates, and/or screws) is used to hold the bone in place. Any injury to the surrounding tendons or muscles is also repaired. Once the soft tissues around the damaged area are healed (i.e. stable), then the cement spacer is filled with bone chips and shavings.
There are many potential advantages to this idea of creating a membrane to protect the local tissues while helping healing. For example, the bone graft is firmly held in place, preventing soft tissues from growing into the healing bone. The technique prevents bone graft resorption while actually stimulating blood supply to the area. The membrane even seems to help foster bone growth. And the cement spacer itself creates a mild inflammatory response, which also speeds up healing.
How long does all this take? The cement spacer stays in place for one to two months -- long enough to allow the membrane to become active. Removal of the spacer may be delayed if there is significant soft tissue injury that needs more time to heal.
Recovery time is still lengthy with full weight-bearing for leg injuries achieved six to 10 months later. Severe arm and/or hand injuries treated this way also require many months for healing and rehab to take place. Full healing of the fractured bone can take up to a full year. But surgeons and patients agree that the time delay is worth it if the limb can be saved from significant shortening or even amputation.
In summary, the idea of creating a membrane to help surgically manage severe or large bone defects caused by fractures has shown some good success. Studies done so far have been small without the benefit of long-term follow-up. But the authors of this review are enthusiastic in the positive results they have had with their patients.
More studies are needed to help identify the best materials to use to create this healing membrane. Likewise, it would be helpful if surgeons had a better idea as to the optimal time frames for each step of the procedure. For now, it appears that managing segmental bone defects with this two-stage induced membrane technique reduces complications, provides a faster healing and recovery time, and prevents limb shortening or amputation.
|
References:
Benjamin C. Taylor, MD, et al. Induced Membrane Technique for Reconstruction to Manage Bone Loss. In Journal of the American Academy of Orthopaedic Surgeons. March 2012. Vol. 20. No. 3. Pp. 142-150.
|
|
|
« Back
|
|
|
|
*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
 | All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission. |
|
