Volume 41, Issue 1, Pages (January 2010)

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Volume 41, Issue 1, Pages 39-47 (January 2010) Clinical Use of Resorbable Polymeric Membranes in the Treatment of Bone Defects Richard P. Meinig, MD Orthopedic Clinics Volume 41, Issue 1, Pages 39-47 (January 2010) DOI: 10.1016/j.ocl.2009.07.012 Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 1 1cm defect of rabbit radius treated with polylactide membrane. Cortical bone has formed along the membrane surface in continuity with the defect ends. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 2 1cm defect of the rabbit radius untreated. Defect has filled with muscle and fibrous tissue. The defect ends have formed cortical caps. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 3 Membrane configurations (A–D). Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 4 CT reconstruction of bone regenerate (A–C). Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 5 High power magnification of membrane-bone interface. Bone has formed in apposition to membrane surfaces without inflammatory or fibrous cell reaction. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 6 Bone formed in a 3cm defect of the minipig radius treated with a polylactide membrane loaded with CaCO3. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 7 (A). Sheep tibia defect stabilized with locked unreamed intramedullary (IM) nail with iliac crest autograft and microporous polylactide membrane. (B) Sheep defect with membrane formed as a tube and filled with iliac crest bone graft. Membrane form maintained by cerclage suture at margins. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 8 (A) Near circumferential cortical defect at diaphyseal metaphyseal junction in Grade II open fracture at 8 weeks. (B) Surgical exposure of medial aspect of defect. (C) Polylactide membrane-mesh formed as a ¾ tube and filled with iliac crest bone graft harvested with acetabular reamer. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 9 (A) High-energy distal tibia fracture. (B) External fixation of distal tibia with placement of antibiotic-polymethyl methacrylate (PMMA) spacer and flap coverage. (C) Defect following antibiotic spacer removal, fixation with a spanning locked plate, RIA autogenous bone graft, and a double tube construct with polylactide mesh. (D, E) Anterior-posterior radiograph and lateral radiographs at 7 months postoperative showing reconstitution of bone defect. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 10 (A, B) Injury film of open Grade IIIb fracture treated with initial external fixation. Intraoperative fluoroscopic view of locked plating and harvesting autogenous bone with RIA. (C, D, E) Implantation of polylactide mesh with RIA autograft. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 11 (A) Injury films. (B) Conversion from temporary external fixation to plate, RIA bone graft, and membrane. (C) Healed defect. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 12 (A) Spanning external fixation and bone resection (B) Bone regenerate after early conversion to IM nail, free flap coverage, RIA bone grafting and membrane implantation. Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions

Fig. 13 (A) Diaphyseal bone loss of distal femur treated with initial debridement and spanning external fixation. (B) Conversion from external fixation to plate fixation with PMMA antibiotic spacer. (C) Bone regenerate after removal of PMMA spacer, RIA bone grafting and membrane implantation (D). Orthopedic Clinics 2010 41, 39-47DOI: (10.1016/j.ocl.2009.07.012) Copyright © 2010 Elsevier Inc. Terms and Conditions