Treatment Strategies of Defect Nonunion with Vascular Damaged by Induced Membrane Technique: Is Two-Stage Treatment Sufficient?

Abstract Introduction: Defect nonunion is often associated with vascular damaged, concomitant infection and unfavorable soft tissue. Although several procedures used for bone defect nonunion, recently the induced membrane (IM) technique has gained great popularity in the world. The aim of this article is to evaluate the efficacy of vascular damaged nonunions with treated IM technique. Patients and Methods: This retrospective study included tibial defect nonunions of twenty-four patients (22 men, 2 women) with treated IM technique, from January 2014 to December 2018. According to the angiography of the extremity, a decrease in blood flow or obstruction in arterial vessels was suggested as vascular damaged group (n = 11) (Group 1), without vascular damaged group (n = 13) (Group 2). All surgeries applied during IM technique treatment including start with cement insertion and until last control were defined as number of surgeries. Results: The average time to union (40.18 ± 10.01 weeks – 38.61 ± 11.20 weeks) and the mean defect size (6.54 ± 1.75 cm – 6.61 ± 1.85 cm), no statistical differences were found between 2 groups (p >0.05). The average of spacer use was 11.27 (6 to 16) and 7.23 (6 to 10) weeks in group 1and 2, respectively. The mean number of surgeries was 3.91 ± 0.83 (at least 3 and at most 5) in group 1 and 2.31 ± 0.48 (2 to 3) in group 2. Conclusion: Although nonunions with vascular damage may require more surgeries and duration to spacer, a similar time to union and union rate were achieved compared to without vascular damage.