Masquelet Technique Combined with Non-vascularized Fibular Strut Graft for Reconstruction of a Large Tibial Bone Defect in a Skeletally Immature Patient: A Case Report.

INTRODUCTION: Compound tibial fractures with large segmental bone defects present a formidable reconstructive challenge, particularly in the skeletally immature population. While the Masquelet-induced membrane technique has emerged as a reliable method for managing critical-sized bone defects, its use with morselized cancellous bone alone limits early weight-bearing and mechanical stability. We describe a modification combining the Masquelet technique with a non-vascularized mid-shaft fibular strut graft to address these limitations.

CASE REPORT: A 14-year-old boy sustained an open fracture of the right tibia and fibula (Gustilo-Anderson type IIIB) with an approximately 6 cm segmental tibial bone defect following a motor vehicle collision. Management involved a staged approach: initial wound debridement and external fixation, followed by open reduction and internal fixation with a dynamic compression plate and polymethylmethacrylate cement spacer impregnated with gentamicin. At 11 weeks, the cement spacer was removed, and the defect was reconstructed using a non-vascularized mid-shaft fibular strut graft placed intramedullarily within the induced membrane, augmented with bi-cortical iliac crest bone graft. The patient achieved partial weight-bearing at 24 weeks, full weight-bearing at 33 weeks, and resumed normal activities by 39 weeks post-injury. Follow-up radiographs demonstrated satisfactory bone union with complete regeneration of the fibular donor site.

CONCLUSION: Combining the Masquelet technique with a non-vascularized fibular strut graft is a viable option for reconstructing large tibial bone defects in skeletally immature patients. This approach provides structural support, reduces cancellous graft requirements, enables earlier weight-bearing, and achieves complete donor site regeneration in the growing skeleton.