Combining non-vascularized fibula and cancellous graft in the masquelet technique: A promising approach to distal femur compound fracture management with large defects.

Introduction: Compound fractures of the distal femur with large defects pose a significant challenge in management, with several options available, including external fixators, bone grafting, the Masquelet-induced membrane technique, and free vascularized fibular grafts. The Masquelet-induced membrane technique involves placing a cement spacer in the defect to create a biologically active membrane. In the second stage, the gold standard for filling the defect is an autologous cancellous bone graft of 1-2 mm in size. This study aims to examine the effects of using a non-vascularized fibula as a support combined with a cancellous graft in the Masquelet technique for treating compound fractures of the distal femur.

Methods: The study was conducted between December 2017 and December 2020 and included 11 patients who underwent the Masquelet technique. The procedure involved a lateral locked plate and an antibiotic-impregnated bone cement spacer, followed by a 20-30 mm longer ipsilateral fibula used as a strut graft. The remaining area was filled with cancellous bone from the iliac crest. The size of the defect, Time to the bony union, the average range of motion of the knee, and any complications are analysed. The final evaluation was done at 18 months using the Lower Extremity functional scale to assess functional outcomes.

Results: The study included 11 patients (8 male and 3 female) with a mean age of 45.8 years. The average time to bony union was 6.6 months, and the average range of motion of the knee was 2.2° to 93.3 ° (0-110 °). No complications such as infection, non-union, or implant failure were observed.

Conclusion: The Masquelet Technique combined with a fibular strut graft is a feasible solution for complex distal femur fractures with bone loss. The non-vascularized fibula graft provides both structural support and reduces the amount of cancellous bone graft needed, which results in earlier weight bearing and improved functional outcomes.