Takagaki Jun, Kumabe Yohei, Fukui Tomoaki, Kuroda Ryosuke, Oe Keisuke
Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Am J Case Rep. 2025 Sep 6;26:e948871. doi: 10.12659/AJCR.948871.
BACKGROUND The treatment of nonunion with deformity and shortening remains a significant challenge in orthopedic surgery. The chipping and lengthening technique is used for bone reconstruction and new bone formation, without the need for bone grafting. However, inadequate bone regeneration can require additional treatment. The Masquelet technique, a 2-stage procedure involving an induced membrane, has been reported to be effective in managing large bone defects and nonunion cases. CASE REPORT We present a case of a 21-year-old man with tibial nonunion associated with deformity and shortening. The patient underwent the chipping and lengthening technique using an external fixator, followed by conversion to internal fixation. However, bone regeneration at the distraction site was insufficient, necessitating salvage surgery using the Masquelet technique. The first-stage procedure involved debridement of the immature regenerate and placement of a cement spacer to induce membrane formation. In the second stage, the cement spacer was removed and replaced with an autologous bone graft. As a result, successful bone union was achieved, enabling the patient to regain full weight-bearing ability without complications. CONCLUSIONS This case highlights the effectiveness of the Masquelet technique as a salvage procedure for inadequate bone regeneration following the chipping and lengthening technique. The combination of these techniques is a viable treatment approach for nonunion cases with deformity and shortening.
背景 伴有畸形和短缩的骨不连的治疗在骨科手术中仍然是一项重大挑战。碎骨与延长技术用于骨重建和新骨形成，无需植骨。然而，骨再生不足可能需要额外治疗。据报道，Masquelet技术是一种涉及诱导膜的两阶段手术，在处理大的骨缺损和骨不连病例方面有效。病例报告 我们报告一例21岁男性患者，患有伴有畸形和短缩的胫骨骨不连。患者首先采用外固定器进行碎骨与延长技术，随后转换为内固定。然而，牵张部位的骨再生不足，因此需要采用Masquelet技术进行挽救手术。第一阶段手术包括清除未成熟的再生组织并放置骨水泥间隔物以诱导膜形成。在第二阶段，取出骨水泥间隔物并替换为自体骨移植。结果，成功实现了骨愈合，使患者恢复了完全负重能力且无并发症。结论 本病例突出了Masquelet技术作为碎骨与延长技术后骨再生不足的挽救手术的有效性。这些技术的联合是伴有畸形和短缩的骨不连病例的一种可行治疗方法。
