Clinical Outcomes of the Induced Membrane Technique for Infected Non-unions and Post-traumatic Bone Defects in a Resource-Limited Setting

TL;DR

This study shows that a surgical technique called the induced membrane technique works well for treating bone defects and infections in low-resource hospitals, with high success rates and few complications.

Contribution

The study provides novel evidence on the effectiveness of the induced membrane technique in resource-limited settings, where such data is scarce.

Findings

80% of patients achieved excellent or good outcomes using the induced membrane technique.

Union rates were higher in younger patients (<40 years) and smaller bone defects (<5 cm).

Infection control was successful in 95% of cases with minimal reinfection risks.

Abstract

Background

Post-traumatic bone defects and infected non-unions pose significant challenges in orthopedic trauma surgery, particularly in low-resource settings. The induced membrane technique (IMT) offers a promising solution, but evidence from resource-constrained environments remains limited. This study evaluates the efficacy of IMT in such settings.

Methods

A prospective cohort study was conducted from May 2023 to May 2024 at a tertiary care hospital in Vadodara, India. Thirty patients with infected non-unions or bone defects (>3 cm) in long bones were enrolled. The two-stage IMT protocol included radical debridement with antibiotic-loaded polymethylmethacrylate (PMMA) spacer placement, followed by autologous bone grafting. Outcomes were assessed using the Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system at six weeks, three months, six months, and 12 months postoperatively.

Results

Among 20 analyzed patients (mean age: 38 years; 75% male), 80% achieved excellent or good outcomes. Union rates were higher in younger patients (<40 years; 85% success rate) and smaller defects (<5 cm; 88% success rate). Complications included deformity (10%) and persistent infection (5%). Infection control was successful in 95% of cases. Stratified analysis revealed better outcomes in trauma-related defects (75%) compared to chronic non-unions (25%).

Conclusion

IMT is a viable, cost-effective option for managing complex bone defects in resource-limited settings, with high success rates and low reinfection risks. Younger age, smaller defects, and absence of comorbidities were associated with superior outcomes. Procedural refinements and biomaterial augmentation could further enhance results.