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Citation: Abid H, Ben Maatoug A, Nefiss M, Tborbi A, Ezzaouia K, Bouzidi R. Masquelet's induced membrane technique for the treatment of bone

hydatid disease.Jr.med.res.2021;4(1): 21-23. Abid et al © All rights are reserved. https://doi.org/10.32512/jmr.3.2.2020/21.23

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Images in clinical practice

Abid Hichem

1,2, *

, Ben Maatoug Aymen

1,2

, Nefiss Mouadh

1,2

, Tborbi Anis

1,2

, Ezzaouia Khlil

1,2

, Bouzidi Ramzi

1,2

Masquelet's induced membrane technique for the treatment of bone hydatid disease.

1: Department of Orthopedics, Mongi

Slim Hospital, Tunis, Tunisia

2: college of medicine, Tunis Tunisia

* Corresponding author

Correspondence to:

hich.abid2112@gmail.com

Publication Data:

Submitted: February 21,2021

Accepted: April 22,2021

Online: May 30,2021

This article was subject to full

peer-review.

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Bone Hydatid disease is a rare entity even in endemic areas. Insidious symptoms onset is

due to progressive infiltration of the parasite into bony tissues. The frequent pseudo-tumoral

presentation of bone parasitosis made its surgical treatment closer to carcinologic

procedures. We report a case of hydatid disease of the femur managed in two-steps induced

membrane surgical technique.

Keywords:

Hydatid cyst; femur; surgical technique.

Introduction

Bone echinococcosis represents only 0.5 to 3% of all hydatid cyst’s locations [1]. This

parasitosis is usually initially asymptomatic. The natural evolution of the parasite is

insidious in such hostile location. The diagnosis is almost always delayed and made

when the lesions are already locally advanced [2]. The aim of this report was to

highlight the pathological characteristics an extended parasitosis of the femur and the

challenging surgical management.

Observation

We present the case of a 57-year-old male, who presented with spontaneous oozing

fistula of the lateral side of the right thigh. On his history, we noted a previous incision

and drainage of abscess in the right thigh one year ago. No germs were identified in

the swab. He consulted us for recurrence of pain, swelling and persistent discharge.

On the examination, Hip and knee range of motion were within normal. The external

fistula orifice was in the distal corner of the previous surgery scar with serous liquid

discharge. There were no inflammatory signs.

Femur X-rays showed multilocular lesion of the diaphysis with cortical deformation.

These characteristics were confirmed by hip MRI scan (Figure 1). Tru-cut biopsy of the

mass confirmed its parasitological origin. Chest and abdomen were free of cyst on the

computed tomography (CT) scans. The diagnosis of peripheral bone echinococcosis

affecting the femur was retained and surgery was indicated.

The plan was to perform a segmental femoral resection excising the lesion and the

surrounding invaded soft tissues; followed by a two-step reconstruction according to

the induced membrane technique. Resection of infected bone and adjacent soft

invaded tissues was performed through femur lateral approach. The surgical site was

abundantly washed with hypertonic saline solution. Bone fixation was performed with

gamma nail. The substance defect was replaced by bone cement (figure 2).

Post-operative course was uneventful and pathological examination of the resected

specimen confirmed the diagnosis of echinococcosis. The patient started oral

antiparasitic treatment course. Six weeks later, he was scheduled for the next

procedure step. Bone cement was removed and replaced by bone autograft from fibula,

anterior and posterior iliac crests. At Twenty months of follow-up, the patient had no

complaints with normal right hip and knee range of motion. X-rays showed satisfactory

evolution (figure 3).

Abstract

Masquelet's induced membrane technique for the treatment of bone hydatid disease

Citation: Abid H, Ben Maatoug A, Nefiss M, Tborbi A, Ezzaouia K, Bouzidi R Masquelet's induced membrane technique for the treatment of bone

Submit your manuscript: www.jmedicalresearch.com.

Figure 1: Plain roentgenogram showing proximal right femur cystic pseudo tumoral mass deforming the cortex.

Figure 2: Intraoperative aspect of the femoral mass.

a b

Figure 3: post-operative follow-up X-rays

a: after first procedure

b: after second procedure

Masquelet's induced membrane technique for the treatment of bone hydatid disease

Citation: Abid H, Ben Maatoug A, Nefiss M, Tborbi A, Ezzaouia K, Bouzidi R Masquelet's induced membrane technique for the treatment of bone

Submit your manuscript: www.jmedicalresearch.com.

Discussion

Masquelet's induced membrane technique is a two-stage procedure described first for the reconstruction of long

segmental bone defects [1]. The first stage requires radical excision and debridement of all devitalized tissues. The

bone defect can be replaced temporarily and fixed internally or externally. The foreign-body immune response

created after the first stage is crucial for the success of the second step [2]. Healthy and well supplied tissues kept

in the first stage will contribute to the formation of vascularized induced membrane and produces multiple growth

factors. This membrane will support bone grafting and accelerate the healing [3]. Masquelet's technique is simple,

effective and reproducible technique for the treatment of several bone diseases such as infection, tumors or

complex traumatism [4]. This technique allowed us to control the hydatid disease in one of its rarest presentation.

Conflict of Interest: None

References

[1] Masquelet AC. The induced membrane technique. Orthop Traumatol Surg Res. 2020 Sep; 106:785-87.

[2] Fung B, Hoit G, Schemitsch E, Godbout C, Nauth A. The induced membrane technique for the management of long bone defects. Bone Joint J. 2020;102-B:1723-34.

[3] Pereira R, Perry WC, Crisologo PA, Liette MD, Hall B, Hafez Hassn SG, et al. Membrane-Induced technique for the management of combined soft tissue and osseous

defects. Clin Podiatr Med Surg. 2021; 38:99-110.

[4] Andrzejowski P, Masquelet A, Giannoudis PV. Induced membrane technique (Masquelet) for bone defects in the distal Tibia, foot, and ankle: Systematic review, case

presentations, tips, and techniques. Foot Ankle Clin. 2020; 25:537-86.