Lotte van der Broeck (Maastricht / NL), Laureanne Lodewijks (Maastricht / NL), Jan Geurts (Maastricht / NL), Shao Qiu (Maastricht / NL), Martijn Poeze (Maastricht / NL), Taco Blokhuis (Maastricht / NL)
Introduction: The optimal treatment strategy for post-traumatic long bone non-unions is subject of an ongoing discussion. At the Maastricht University Medical Center (MUMC+) the induced membrane technique is used to treat post-traumatic long bone non-unions. This technique uses a multimodal treatment algorithm involving bone marrow aspirate concentrate (BMAC), the reamer-irrigator-aspirator (RIA) and P-15 bioactive peptide (iFactor, Cerapedics). When infection is suspected, bioactive glass (S53P4 BAG, Bonalive) is added. This study aims to objectify the effect of this treatment algorithm on the health-related quality of life (HRQoL) of patients with post-traumatic long bone non-unions. We hypothesized that HRQoL would improve after treatment.
Methods: From January 2020 to March 2023, MUMC+ evaluated patients with post-traumatic long bone non-unions using the Non-union severity score (NUSS). The EuroQol-5D-5L and Lower Extremity Functional Score (LEFS) were used to measure HRQoL before and after surgery, with follow-ups at 6, 18, and 35 weeks.
Results: At baseline (T0), 76 patients had a mean NUSS of 40 (±13 SD). Thirty-eight had their first follow-up at 6 weeks (T1), 31 at 18 weeks (T2), and 20 at 35 weeks (T3). The EQ-5D index mean increased from 0.480 at T0 to 0.618 (T1), 0.636 (T2), and 0.702 (T3). HRQoL showed a significant difference between T0 and T1, as well as T2 and T3 (p<0.001; p=0.011). The LEFS improved from 26 pre-intervention to 34, 39, and 43 after treatment (p<0.001; p=0.033; p=0.016).
Conclusion: This study demonstrated significant improvement in the health-related quality of life of patients with post-traumatic long bone non-unions after the multimodal treatment following the induced membrane technique.
Brinker MR. et al., Debilitating Effects of Femoral Nonunion on Health-Related Quality of Life. Journal of Orthopaedic Trauma. 2017;31(2):e37-e42.
Masquelet, A. Induced Membrane TechniquePearls and Pitfalls.Journal of Orthopaedic Trauma, 2017.
The Maastricht Universiteit Medisch Centrum has a consortium agreement with Cerapedics and Osteopore.
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