The Induced Membrane Technique for Bone Defects in the Hand and Upper Extremity: A Case Series.

Abstract

We present a series of cases in which the induced membrane technique (IMT) was used to treat segmental bone defects from trauma and chronic infection nonunion in the hand and upper extremity. The aims of the study were to present the rates of union and complications using this technique. Our institutional database was queried between 2012 and 2018. Patients who met the inclusion criteria with segmental defects either from acute trauma or chronic infection nonunion were included in the study. A retrospective review of their charts was performed documenting patient demographics, size of bone defect, time to union, mechanism of injury, and postoperative complications. A total of 13 patients met the inclusion criteria, and their individual charts and operative notes were reviewed. Eleven patients had acute traumatic bone loss, and the remaining 2 patients were treated for postoperative chronic infection nonunion as confirmed with positive cultures taken at the nonunion site. Rate of union after the index procedure was 84.6%, and average time to union was 14 weeks. The mean bone defect length was 2.73 cm. 46.1% of patients had soft tissue defects and complications requiring additional procedures for soft tissue coverage. The IMT is an alternative means of treating segmental bone defects in the upper extremity but can present with challenges resulting in persistent nonunion and complications with soft tissue reconstruction.