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      Salvage of mangled upper extremity using the Masquelet technique in a child: A case report

      case-report

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          Abstract

          Aim:

          To report our experience with the Masquelet concept in a pediatric upper extremity following an open injury to the elbow.

          Methods:

          A case report and literature review.

          Results:

          An 11-year-old boy was transferred to our institution after a motor vehicle collision. There was a primary loss of the ulnohumeral articulation and the surrounding soft tissues as well as the ulnar nerve. Reconstruction used the Masquelet-induced membrane technique and a soft tissue flap. At the 30-month follow-up, the extremity was pain free and functional.

          Conclusion:

          This case highlights the value of the Masquelet technique in pediatric extremity injuries, where there is a loss of a major articular segment, as well as significant soft tissue compromise.

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          Most cited references17

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          Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration.

          Ph Pelissier, A C Masquelet, R Bareille … (2004)
          Based on a new concept, a procedure combining induced membranes and cancellous autografts allows the reconstruction of wide diaphyseal defects. In the first stage of this procedure, a cement spacer is inserted into the defect; the spacer is responsible for the formation of a pseudo-synovial membrane. In the second stage, the defect is reconstructed two months later by an autologous cancellous bone graft. The aim of this study was to evaluate the histological and biochemical characteristics of these membranes induced in rabbits. Histological studies carried out two, four, six, and eight weeks following implantation revealed a rich vascularization. Qualitative and quantitative immunochemistry showed production of growth factors (VEGF, TGFbeta1) and osteoinductive factors (BMP-2). Maximum BMP-2 production was obtained four weeks after the implantation, and, at this time, induced membranes favored human bone marrow stromal cell differentiation to the osteoblastic lineage. Should these results be confirmed in humans, bone reconstruction could be carried out earlier than previously thought and in better conditions than expected, the membrane playing the role of an in situ delivery system for growth and osteoinductive factors.
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            Treatment of posttraumatic bone defects by the induced membrane technique.

            C Karger, T. Kishi, L. Schneider … (2012)
            Among bone reconstruction techniques, the induced membrane technique, proposed in 1986 by Masquelet, has rarely been studied or evaluated in the surgical literature until recently. The 2010 French Society of Orthopaedic Surgery and Traumatology (SoFCOT) Annual Convention symposium was the occasion to evaluate a large cases series having used this technique.
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              Two-stage reconstruction of post-traumatic segmental tibia bone loss with nailing.

              T Apard, N Bigorre, P Cronier … (2010)
              Treatment of lower extremity segmental bone loss is difficult. Masquelet et al. proposed a two-stage technique: first, debridement and filling of bone loss with an acrylic spacer; second, bone reconstruction by filling with cancellous bone in the space left free (following cement removal) inside the so-called self-induced periosteal membrane. In the originally described technique, the fracture site is stabilized by an external fixator, which remains in place throughout the bone healing process, i.e., often longer than 9 months with all the known disadvantages of this type of assembly. Following the principle of two-stage reconstruction, we modified the technique by reconstructing around an intramedullary-locking nail placed in the first stage.
              Article 0 comments Cited 51 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): SAGE Open Med Case Rep
                Journal ID (iso-abbrev): SAGE Open Med Case Rep
                Journal ID (publisher-id): SCO
                Journal ID (hwp): spsco
                Title: SAGE Open Medical Case Reports
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Electronic): 2050-313X
                Publication date (Electronic): 16 November 2017
                Publication date Collection: 2017
                Volume: 5
                Electronic Location Identifier: 2050313X17741011
                Affiliations
                [1 ]Department of Surgical Specialties, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
                [2 ]General Department of Medical Services, Ministry of Interior, Riyadh, Kingdom of Saudi Arabia
                Author notes
                [*]Nabil Alassaf, Department of Surgical Specialties, King Fahad Medical City, P.O. Box 59046, Riyadh 11525, Kingdom of Saudi Arabia. Email: nalassaf@ 123456kfmc.med.sa
                Article
                Publisher ID: 10.1177_2050313X17741011
                DOI: 10.1177/2050313X17741011
                PMC ID: 5697582
                SO-VID: 774f5881-6781-4038-b253-0032be697fe6
                Copyright © © The Author(s) 2017
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 21 March 2017
                Date accepted : 16 October 2017
                Categories
                Subject: Case Report
                Custom metadata
                cover-date January-December 2017

                Keywords: masquelet technique,induced membrane,elbow arthrodesis,mangled extremity,pediatric
                Data availability:
                Keywords: masquelet technique, induced membrane, elbow arthrodesis, mangled extremity, pediatric

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