Masquelet technique in adolescent distal humerus fractures with bone loss

Adolescent distal humerus fractures usually result from high-energy trauma; however, open fractures with associated bone loss are quite rare. Although the Masquelet technique has demonstrated proven success in the reconstruction of lower extremity bone defects, its use in upper extremity periarticular defects, especially in adolescents, has been very rarely reported. This study aims to present the clinical and radiological outcomes of the Masquelet technique in adolescent distal humerus fractures with bone loss. A retrospective review was conducted of patients aged 12-16 years who underwent the Masquelet technique for distal humerus bone defects at a level 1 trauma center. Four patients who met the inclusion criteria were evaluated. Data collected included demographic characteristics, fracture characteristics, defect size, surgical details, time to union, range of motion (ROM), and functional outcomes assessed by the Mayo Elbow Performance Score (MEPS). The mean defect size was 6.4 cm2 (range 4.8-10.2 cm2). The interval between stages averaged 42.7 days. Radiographic union was achieved in all patients at a mean of 13.3 weeks (range 12-15). At 2-year follow-up, the mean elbow ROM was 122.5° (range 110°-130°). MEPS scores were excellent in two patients and good in two patients. No infection or neurovascular complications were observed. Tricortical iliac crest autografts combined with cancellous grafts were used in all cases. The Masquelet technique appears to be a feasible and effective option for the treatment of rare adolescent distal humerus fractures with bone loss. Larger prospective studies are required to clarify optimal graft selection, the use of antibiotic-loaded spacers, and the timing of the second stage in this rare clinical entity.