Management of tibial non-unions with Masquelet technique after failed previous treatment options for Grade III open fractures

BACKGROUND: Non-union is a serious complication of open tibial fractures. This case series investigates the efficiency of the induced membrane technique in patients with tibial exposed non-union. METHODS: Eleven consecutive male patients with non-union after an open tibia fracture were enrolled into the study. The mean age of the patients was 40.7 (25-63). Induced membrane technique described by Masquelet was performed. Operative treatment with a temporary polymethylmethacrylate cement spacer to induce membrane formation followed by spacer removal and bone grafting at 7.35 (6-10) weeks were performed. Time to union, time to full weight-bearing, and any complications were evaluated. RESULTS: The average follow-up period of patients was 24.6 (13-40) months after the second stage. The mean length of bone defects after radical debridement was 51 mm (25-98). Fracture healing was observed in 9 patients (81%). The mean time needed to obtain bony union healing was 8.1 (8-12) weeks after second stage of surgery. Patients were allowed to full weight bearing as tolerated at 12 weeks. Two patients were failed to obtain bony union and infection control. One patient had below knee amputation due to persistant infection. Vascularized bone graft was performed for other patient due to the inability to obtain bone union. CONCLUSION: The induced membrane technique is a reliable and reproducible treatment modality for tibial non-unions after failed open fracture treatment. However, it is unpredictable to obtain bony union and control of infection in initial infected non-unions with a large bone defect.