الفهرس | Only 14 pages are availabe for public view |
Abstract Segmental bone defects reconstruction is not an easy mission and represents a challenge in orthopaedic surgery. Many options can be used for this issue but each has its difficulty and complications like the use of Ilizarov technique with distraction osteogenesis, which complicated with pin track infection, joint stiffness, chronic limb edema swelling, and needs a highly compliant and motivated patients. Also, Use of Vascularized bone grafts like fibula which needs a special microscopic skills and long duration time. Direct autogenous bone grafting is not recommended for large bone defects due to graft resorption and failure of achieving bone union. Induced membrane technique is a simple, straight-forward technique that requires a good preoperative planning and depends on creation of a membrane with biological value similar to the periosteum via foreign body reactions after application of PMMA spacer in the defect. Beside the biological value of the membrane, it also helps to maintain the bone grafts in place, maintain the shape of the regenerated bone, prevent it resorption, and prevent the intravasation of the surrounding soft tissues in the defects. This technique was invented by the French Orthopaedic surgeon Alain charles Masquelet by chance in 1986, and with time, more researches were done on it and different results of success ranging from 85% to 100 %. Our result was within the published range (94.12%) which was achieved on 17 cases from the original 20 cases that were admitted from Out Patient Clinics or from the Emergency Hospital with bone defects from 5 to 27 cm and included in prospective study. 17 cases were compliant and follow the plan of management, 2 cases died from pulmonary metastasis, 1 case missed her follow up. from the 17 cases that followed the instructions, 16 cases end with bony healing and 1 case failed resulted in 94.12% healing rate. The use of Intramedullary devices with their load sharing property and Bone substitutes ( HA-TCP) with its compressive strength which is more than the cancellous autograft allows early weight bearing and increase the patient confidence to weight bear with little fears. RIA (Reamer Irrigator Aspirator) is proved to be a better source of plenty Cancellous autograft up to 80 cc from each femur with minimal donor site complications, has high biological contents that lead to early union and consolidation (up to 4 months) than other sources of bone grafts with or without bone extenders, But Costly. |