Salvage Masquelet Technique for Insufficient Bone Regeneration Following Chipping and Lengthening in Tibial Nonunion: A Case Report

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.