Masquelet’s induced membrane technique in the upper limb: a systematic review of the current outcomes

Journal of Orthopaedics and Traumatology Pederiva et al. Journal of Orthopaedics and Traumatology (2025) 26:4 https://doi.org/10.1186/s10195-024-00815-w Open Access SYSTEMATIC REVIEW Masquelet’s induced membrane technique in the upper limb: a systematic review of the current outcomes Davide Pederiva1,2* , Lapo De Luca1, Cesare Faldini2 and Luigi Branca Vergano1 Abstract Background The Masquelet induced membrane technique is a surgical procedure that allows the reconstruction of segmental bone defects using a relatively simple approach that requires minimal resources from both the healthcare facility and the patient. Historically applied to the lower limb, this technique is gaining increasing attention in the literature for its use in the upper limb. Methods A systematic review of the literature was conducted using the PubMed and Google Scholar databases to identify all studies reporting the outcomes of the Masquelet induced membrane technique in the long bones of the upper limb (humerus, radius, and ulna) with a sample size of at least 3 patients. The papers had to include the length of the bone defect, a description of the protocol used for treatment, the complications of each case, and the anatomical location of the defect. The studies that did not meet the above inclusion criteria were excluded. Results The search identified 1044 studies, of which 15 met the inclusion criteria. These studies described a total of 156 patients with a mean age of 42 years. The affected bone segments included the humerus in 22 cases and the forearm in 134 cases. In 108 cases, the bone defect was septic. The average defect length was 4.5 cm. PMMA was used as a spacer in all cases, with antibiotics added in 77% of them. The average time interval between the first and second phases of the procedure was 9.5 weeks, and bone union took an average of 5.5 months. The mean followup duration was 48 months, and the complication rate was 21%, ranging from 0% to 75%. Conclusions The Masquelet induced membrane technique is a viable surgical option for managing segmental bone defects of the upper limb. However, the complication rate remains significant. Further research is needed to identify strategies to improve the outcomes of this technique. Level of Evidence: Level 2. Keywords Masquelet, Induced membrane, Upper limb, Bone defect *Correspondence: Davide Pederiva 1 Unità Operativa di Ortopedia e Traumatologia, APSS Trento, Largo Medaglie d’oro, 9, 38121 Trento, Italy 2 IRCCS Rizzoli Orthopedic Institute, Bologna, Italy Introduction Managing segmental bone defects represents one of the most complex challenges in orthopedics and traumatology, with significant implications for patients’ quality of life [1]. These defects can result from trauma, infections, tumor resections, or other pathologies, and their treatment requires a multidisciplinary and personalized approach [2]. Over the years, various therapeutic strategies have been developed to address this issue, each with specific advantages and limitations. © The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Pederiva et al. Journal of Orthopaedics and Traumatology (2025) 26:4 Traditionally, bone defects were filled with autologous bone grafts, which still represent the gold standard for bone regeneration. Autologous cancellous bone grafts, whether harvested from the iliac crest or via reamer–irrigator–aspirator (RIA), primarily serve as an osteoconductive substrate with osteogenetic and osteoinductive properties [3]. However, this strategy has three significant limitations. The amount of bone that can be harvested is limited [4], associated complications are non-negligible [5]; and the bone defect that needs to be filled must be less than 5 cm in length, as larger defects would not heal due to physiological graft resorption [6, 7]. When primary grafting of the bone defect is likely to fail, alternative therapeutic strategies are available. Acute shortening of up to 5 cm is an option for the upper limb but is seldom accepted by the patient [1]. Distraction osteogenesis has shown a high success rate in managing bone defects [8], but it comes with a prolonged reconstruction time, which is why its indication in the upper extremity is very limited [9]. Vascularized fibula grafting is another therapeutic solution [10], but it requires high microsurgical expertise and is associated with considerable donor-site morbidity [11]. In this context, the induced membrane technique (MIMT) described by Masquelet and Begue [6] is particularly relevant. This technique involves reconstructing the bone defect through two well-defined phases [6]: an initial phase of thorough debridement of non-viable tissues and of filling the defect with a spacer, followed by a second phase where the spacer is removed and the defect is filled with bone graft while preserving the induced membrane. The potential advantages of MIMT compared to the aforementioned techniques are numerous [12, 13]: it does not require specialized tools or high costs, it involves less complex surgery, the interval between the two phases allows optimal management of soft tissues, it does not demand significant patient compliance, and the time required for bone consolidation is independent of the defect size. Despite the documented successes of the Masquelet technique in the lower limbs, its adoption in the upper limb is less common and less studied. Anatomical differences, the functional complexity of the upper limb, and the need to preserve joint mobility present challenges that make the application of the technique particularly complex. However, the potential of this approach is promising, and there is a growing interest in extending its use to this anatomical region, as evidenced by the significant increase in publications on the topic over the past 5 years. The most recent systematic review [2] of the literature on the use of the Masquelet technique in the upper limb dates back to studies published before 2019 and Page 2 of 8 indiscriminately considered all upper-limb bones without differentiating between the humerus and forearm versus the clavicle and metacarpals. Since we believe that t (...truncated)