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Extracorporeal Fabrication of a Polymethylmethacrylate Spacer: A Minor Masquelet Modification

March 01, 2017

Contributors: John Calhoun Peterson Floyd, MD; Jason Ganz, MD; Mark Gelfand, MD; Ryan Kottmeier; Randall Madison, MD; Stephen Kottmeier, MD; Stephen Kottmeier, MD

Traumatic skeletal defects are a considerable therapeutic challenge. Soft-tissue and osseous deficits must be managed simultaneously, often resulting in unpredictable outcomes in the absence of treatment algorithms. Several methods are available for osseous regeneration, most of which require advanced skills and resources. The induced-membrane technique described by Masquelet is elegant in its simplicity and offers seemingly predictable and gratifying outcomes. The inclusion of intramedullary fixation may eliminate the complications and failure associated with external fixation and plate fixation. The introduction and extraction of a spacer in combination with intramedullary fixation has been problematic. Disadvantages include the fabrication of spacers with an undesirable design and the risk of the exothermic process to regional tissues. The most readily apparent complication is the atraumatic removal of an intact cylindrical spacer (surrounding the previously introduced nail) without compromising the newly established membrane. This video discusses a minor modification that addresses these technical concerns. Several case studies are discussed, and pearls and pitfalls are reviewed.

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