Induced membrane technique with plate fixation has a lower complication rate than bone transport over a plate for segmental tibial defects larger than 5 cm

Daniel W R Seng; Chang-Wug Oh; Joon-Woo Kim; Kyeong-Hyeon Park; Jong-Keon Oh; Yong-Cheol Yoon

doi:10.1007/s00402-024-05262-0

Induced membrane technique with plate fixation has a lower complication rate than bone transport over a plate for segmental tibial defects larger than 5 cm

Arch Orthop Trauma Surg. 2024 Feb 28. doi: 10.1007/s00402-024-05262-0. Online ahead of print.

Authors

Daniel W R Seng¹, Chang-Wug Oh², Joon-Woo Kim³, Kyeong-Hyeon Park⁴, Jong-Keon Oh⁵, Yong-Cheol Yoon⁶

Affiliations

¹ Department of Orthopaedic Surgery. Woodlands Health, National Health Group, Singapore, Singapore.
² Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea. cwoh@knu.ac.kr.
³ Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944, Republic of Korea.
⁴ Department of Orthopaedic Surgery, Severance Children's Hospital, Yonsei University, College of Medicine, Seoul, 03722, Republic of Korea.
⁵ Department of Orthopaedic Surgery, School of Medicine, Korea University , Korea University Guro Hospital, Seoul, 10408, Republic of Korea.
⁶ Orthopaedic Trauma Division, Trauma Center, Gachon University, College of Medicine, Incheon, 21565, Republic of Korea.

PMID: 38416139
DOI: 10.1007/s00402-024-05262-0

Abstract

Introduction: The treatment of segmental tibial bone defects remains a surgical challenge. While Bone Transport (BT) and Induced Membrane Technique (IMT) are effective strategies for regenerating bone, there are few comparative studies between them. This investigation undertakes a comparative analysis of BT and IMT for large segmental tibial defects stabilised through plate fixation.

Materials and methods: Patients with segmental tibial defects exceeding 5 cm were prospectively enrolled from 2008 to 2021 in a single institution, with a minimum follow-up duration of two years. All patients underwent either BT or IMT with plate fixation of the tibia. Procedural success, primary union as well as bone and functional outcome scores were compared. Complications, including non-unions, joint contractures and deep infections requiring surgical intervention, were also compared.

Results: 41 patients were recruited in total. 28 patients underwent Bone Transport Over a Plate (BTOP), while 13 patients underwent IMT with Plate fixation (IMTP). The procedural success rate trended higher in IMTP compared to BTOP (100% vs. 85.7%). The primary union rate also trended higher in IMTP compared to BTOP (92.3% vs. 79.2%). BTOP and IMTP achieved similar rates of satisfactory bone outcome scores (78.6% vs. 84.6%) and functional outcome scores (75% vs. 76.5%). There was no statistical difference between procedural success, primary union, bone and functional outcome scores. The complication rate in BTOP was 78.6% (22 of 28), including five docking site or regenerate non-unions, eight deep infections and nine joint contractures. IMTP had a 38.5% (5 of 13) complication rate, including one non-union, two deep infections and two joint contractures. The complication rate was 2.04 times higher in BTOP compared to IMTP (p = 0.0117).

Conclusions: BTOP and IMTP are both equally effective techniques for regenerating bone in large tibial bone defects. However, IMTP may be a safer procedure than BTOP, with a lower probability of requiring additional procedures to address complications.

Keywords: Bone loss; Bone transport; Induced membrane.