Treatment of infected tibial nonunion with angular deformity and shortening using the Masquelet technique combined with the Ilizarov technique: A case report

The induced membrane technique (Masquelet technique) combined with the Ilizarov technique may provide a novel strategy for managing infected nonunion with angular deformity and limb shortening within a relatively short treatment period. We report a 45-year-old male with a Gustilo-Anderson type IIIA open tibial fracture complicated by fracture-related infection, 33° valgus deformity, and 50-mm limb shortening. Treatment was performed in three stages: radical debridement with rapid soft-tissue lengthening at 3 mm/day using an Ilizarov external fixator; definitive fixation with an intramedullary nail and Masquelet technique; and cancellous bone grafting with beta-tricalcium phosphate, delayed to 10 months after the second stage due to psychiatric comorbidity. Bone healing was achieved uneventfully within 2 years, with a residual limb-length discrepancy of <1 cm and good functional recovery. This case illustrates that rapid soft-tissue lengthening can effectively correct limb shortening and malalignment, thereby reducing the duration of external fixation and its complications. Moreover, delayed bone grafting did not compromise bone healing, underscoring the robustness of the Masquelet technique combined with intramedullary nail fixation. Overall, this combined approach represents a promising strategy for complex infected nonunions, reducing patient burden while ensuring reliable bone reconstruction and functional recovery.