Masquelet technique combined with Ilizarov external fixation for the management of large femoral defects: A neglected technique

Large segmental femoral bone defects resulting from severe trauma, infection, or tumor resection present significant surgical challenges. Traditional methods like the Ilizarov bone transport technique and Masquelet technique are effective but have limitations. This study reports two cases of post-traumatic femoral bone defects successfully managed using a combination of the Masquelet technique and Ilizarov external fixation. The Masquelet technique, a two-stage process, involves the use of polymethyl methacrylate (PMMA) cement to induce membrane formation, followed by bone grafting at the second stage. The Ilizarov external fixator, known for its stability and versatility, was used to provide more rigid fixation than the monolateral device and to help prevent complications such as infection and nonunion. In both cases, the patients sustained open, high-energy femoral fractures with extensive bone loss and associated soft tissue defects. The Masquelet technique was used to manage the bone defects and the Ilizarov external fixator was employed to ensure stability, allow early mobilization and provide the option of bone transport if necessary. Both patients achieved fracture union with satisfactory functional outcomes. The combination of these techniques effectively addresses the biological and mechanical challenges of large femoral defects, offering a promising solution when internal fixation is not feasible. This approach can be considered a valuable addition to the treatment armamentarium for complex femoral fractures, particularly in cases with infection risk or severe bone loss.