The Masquelet procedure gone awry

The Masquelet technique was first performed in 1986. It is a 2-stage procedure for healing of substantial bone defects, with or without the presence of infection. In the former situation, a thorough debridement of the infected site is necessary to achieve a clean cavity. A cement block is fashioned to fit into the entire defect to act as a spacer that maintains the space for grafting and reconstruction and induces a synovial-like membrane. The induced membrane avoids resorption of the bone graft and secretes growth factors, including vascular and osteoinductive factors, to promote revascularization of the graft. The membrane has an inner part that is a synovial-like epithelium and an outer part composed of fibroblasts, myofibroblasts, and collagen. It is richly vascularized. After a period of 6 to 8 weeks, the spacer is removed by incising the induced membrane that has formed. Copious bone graft, usually autologous and obtained from the iliac crest or by other means, is placed into the defect that is now lined by the induced membrane. The membrane is closed over the graft. This article describes a young patient who started on the correct path for a Masquelet procedure only to have it turn in the wrong direction. However, the problem was not recognized until 8 years after the initial injury. The situation was corrected by performing the final stage of the procedure as it was originally described.