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      The induced membrane technique in animal models: a systematic review

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          Abstract

          Objectives:

          The induced membrane technique (IMT) is a 2-stage surgical approach that has become increasingly popular to manage bone defects. Preclinical investigations have been conducted to better understand and define several aspects of this technique. This review summarizes the literature regarding the IMT performed in animal models and identifies potential future directions.

          Data Sources:

          Biosis Citation Index, Ovid Embase, and Ovid MEDLINE databases were searched from inception up to June 23, 2021 for articles related to the IMT.

          Study Selection:

          Animal studies involving the use of the IMT for segmental defects in long bones were selected. Only full-length original research articles published in English or French were included.

          Data Extraction:

          Two authors extracted the data from the selected studies and a third author verified the accuracy of the information.

          Data Synthesis:

          Information concerning the animal model, the surgical procedures, and the outcome measures were recorded for each study and compiled.

          Conclusions:

          Forty-seven studies were included in this review. Twenty-nine studies (62%) performed both stages of the technique, but only 8 (17%) reported on radiographic union rates explicitly and 5 (11%) included biomechanical testing. A large proportion of the preclinical literature on the IMT has failed to report on radiographic union as an outcome. While studies reporting membrane properties are valuable, they may not provide information that translates into clinical practice or further clinical research if the ultimate outcome of bony healing is not considered. Future animal studies of the IMT should consider this in their study design.

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          Most cited references56

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          Epidemiology of Fracture Nonunion in 18 Human Bones.

          Failure of bone fracture healing occurs in 5% to 10% of all patients. Nonunion risk is associated with the severity of injury and with the surgical treatment technique, yet progression to nonunion is not fully explained by these risk factors.
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            Tibia shaft fractures: costly burden of nonunions

            Background Tibia shaft fractures (TSF) are common for men and women and cause substantial morbidity, healthcare use, and costs. The impact of nonunions on healthcare use and costs is poorly described. Our goal was to investigate patient characteristics and healthcare use and costs associated with TSF in patients with and without nonunion. Methods We retrospectively analyzed medical claims in large U.S. managed care claims databases (Thomson Reuters MarketScan®, 16 million lives). We studied patients ≥ 18 years old with a TSF diagnosis (ICD-9 codes: 823.20, 823.22, 823.30, 823.32) in 2006 with continuous pharmaceutical and medical benefit enrollment 1 year prior and 2 years post-fracture. Nonunion was defined by ICD-9 code 733.82 (after the TSF date). Results Among the 853 patients with TSF, 99 (12%) had nonunion. Patients with nonunion had more comorbidities (30 vs. 21, pre-fracture) and were more likely to have their TSF open (87% vs. 70%) than those without nonunion. Patients with nonunion were more likely to have additional fractures during the 2-year follow-up (of lower limb [88.9% vs. 69.5%, P < 0.001], spine or trunk [16.2% vs. 7.2%, P = 0.002], and skull [5.1% vs. 1.3%, P = 0.008]) than those without nonunion. Nonunion patients were more likely to use various types of surgical care, inpatient care (tibia and non-tibia related: 65% vs. 40%, P < 0.001) and outpatient physical therapy (tibia-related: 60% vs. 42%, P < 0.001) than those without nonunion. All categories of care (except emergency room costs) were more expensive in nonunion patients than in those without nonunion: median total care cost $25,556 vs. $11,686, P < 0.001. Nonunion patients were much more likely to be prescribed pain medications (99% vs. 92%, P = 0.009), especially strong opioids (90% vs. 76.4%, P = 0.002) and had longer length of opioid therapy (5.4 months vs. 2.8 months, P < 0.001) than patients without nonunion. Tibia fracture patterns in men differed from those in women. Conclusions Nonunions in TSF’s are associated with substantial healthcare resource use, common use of strong opioids, and high per-patient costs. Open fractures are associated with higher likelihood of nonunion than closed ones. Effective screening of nonunion risk may decrease this morbidity and subsequent healthcare resource use and costs.
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              The concept of induced membrane for reconstruction of long bone defects.

              Clinical, experimental, and fundamental studies have shown the interest of a foreign body-induced membrane to promote the consolidation of a conventional cancellous bone autograft for reconstruction of long bone defects. The main properties of the membrane are to prevent the resorption of the graft and to secrete growth factors. The induced membrane appears as a biological chamber, which allows the conception of numerous experimental models of bone reconstruction. This concept could probably be extended to other tissue repair.
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                Author and article information

                Journal
                OTA Int
                OTA Int
                OI9
                OTA International
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2574-2167
                March 2022
                10 March 2022
                : 5
                : 1 Suppl
                : e176
                Affiliations
                [a ]Keenan Research Center for Biomedical Science, St. Michael's Hospital – Unity Health Toronto, University of Toronto, Toronto
                [b ]Division of Orthopaedic Surgery, Department of Surgery, University of Western Ontario, London
                [c ]Division of Orthopaedics, Department of Surgery, University of Toronto and St. Michael's Hospital – Unity Health Toronto, Toronto, Ontario, Canada.
                Author notes
                []Corresponding author. Address: 55 Queen Street East, Suite 800, Toronto, ON M5C 1R6, Canada. Tel: +416 864 6017; fax: +416 359 1601. E-mail address: Aaron.Nauth@ 123456unityhealth.to (A. Nauth).

                The authors have no conflicts of interest to disclose.

                Source of funding: Nil.

                Parts of this work were presented at the 2019 Annual Meeting of the Orthopaedic Research Society (Austin, TX) and at the 2019 Meeting of the International Combined Orthopaedic Research Societies (Montréal, Canada).

                Supplemental digital content is available for this article.

                Article
                OTAI-D-21-00087 00007
                10.1097/OI9.0000000000000176
                8900461
                35282388
                fdc9a3d0-b2a7-4a86-a31e-a6205916b2ec
                Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Orthopaedic Trauma Association.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 24 November 2021
                : 15 December 2021
                Categories
                Clinical/Basic Science Research Article
                Custom metadata
                TRUE

                bone defect,bone regeneration,induced membrane technique,masquelet technique,nonunion

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