Reconstruction of a post-traumatic tibial defect of 10 cm in a 6 month old induced membrane by non-vascularised fibula autograft – A case report

Abstract

Reconstruction of post-traumatic large bone defect in tibia is a surgical challenge. Masquelet technique is a two stage procedure to achieve bone union. After cement spacer implantation in defect, optimal time for 2nd stage bone grafting is at 1 month. After 2 months, osteoinductive property of induced membrane is doubtful. We managed a post- traumatic tibial defect of 10 cm with cement spacer as 1st stage of Masquelet procedure. But 2nd stage was delayed for 6 months at which time osteoinductive property of induced membrane was doubtful. Osteopenia, pin track infection with stiff knee and ankle made 2nd stage surgery more challenging. We reconstructed 6 months old induced membrane with 12 cm non-vascularised fibula autograft in combination of cancellous autograft from iliac crest. The construct was fixed with locking compression plate on medial side. Patient achieved bone consolidation and successful union at 9 months with knee flexion of 100 degrees. This case demonstrated that induced membrane is able to preserve osteoinduction property even up to 6 months and with good structural support like fibula strut graft, successful reconstruction is possible in delayed 2nd stage of Masquelet technique.