Masquelet technique including a multiperforated non-vascularized fibula graft for the reconstruction of massive post-traumatic bone defects in military practice.

Abstract

Background: The management of extensive bone defects presents a significant challenge for military orthopedic surgeons, especially in the context of a high intensity conflict or when patients are fully treated in the field. The objective was to evaluate the induced membrane technique (IMT) including a multiperforated non-vascularized fibular graft (NVFG) for the reconstruction of massive bone defects performed in both the ideal conditions of military trauma centers and the austere environment of forward surgical units.

Methods: A retrospective case study was conducted on patients who underwent the above procedure in various care settings between January 2019 and June 2023. Outcomes measured included the achievement of bone union, time to bone union, and the healing index (time to bone healing/length of reconstructed bone). Functional assessment was based on the Quick-DASH score and the lower extremity functional scale (LEFS).

Results: Nine patients with a mean age of 37 years were included: five were managed in a role 4 medical treatment facility (MTF) and four in a role 2 MTF. Five patients had an infected bone defect before IMT application. After debridement, the mean bone defect length was 14 cm, and the mean bone defect volume was 190 cm³. The mean interval between stages was 15 weeks. The mean follow-up was 20 months. Bone union was achieved in 8/9 cases with a mean time of 8.1 months and a mean healing index of 0.58 month/cm. Only the patient with persistent humeral nonunion had a poor DASH-score. The mean LEFS was 68%.

Conclusions: In this small cohort, IMT including a multiperforated NVFG enabled successful reconstruction of massive bone defects in the femur, tibia, and humerus, even in the austere environment of forward surgical units, provided that prior infection control had been achieved.