Bone defect size and healing outcomes in femoral and tibial fracture-related bone defects treated with the Masquelet technique

BACKGROUND: Lower limb fractures with large bone defects (BDs) are uncommon and represent a major therapeutic challenge, often leading to unpredictable healing outcomes. Few studies have specifically assessed the impact of BD size on bone regeneration. The primary objective of this study was to evaluate the consolidation rate of the Masquelet technique in femoral and tibial bone defects. Secondary objectives were to analyse healing time, complications and prognostic factors. METHODS: We conducted a retrospective single-centre study, including 60 patients treated between January 2018 and June 2023 for femoral or tibial non-union using the Masquelet technique. Patients were divided into two groups according to defect size: <5 cm (n = 41) and ≥5 cm (n = 19). Consolidation rates, healing time, complications and reoperations were compared. Multivariate analysis was performed to assess the influence of defect size, adjusting for established local risk factors. RESULTS: Radiological consolidation was achieved in 82.9% of patients with defects <5 cm and in 68.4% of patients with defects ≥5 cm, a difference that was not statistically significant (p > 0.05). Mean healing time was 6.3 months in the <5 cm group versus 8.4 months in the ≥5 cm group. Complication and reoperation rates were comparable. Multivariate analysis identified tibial location, defects <5 cm, and segmental defects as independent predictors of successful healing. Segmental defects were associated with an 82% reduction in the risk of complications (adjusted OR = 0.18). CONCLUSION: The Masquelet technique is a reliable option for managing non-unions with substantial bone loss. Although crude comparisons did not demonstrate a significant effect of defect size on consolidation, adjusted analyses showed that segmental tibial defects smaller than 5 cm are associated with successful healing. Larger prospective studies are needed to confirm these findings. LEVEL OF EVIDENCE: III; Therapeutic studies, Retrospective comparative study.