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Clinical and Functional Outcomes of Bone Defect Reconstruction Using the Masquelet Technique: Experience with Rare
Ahmet Temiz1, Okkes Bilal2, Duran Topak2
1Department of Orthopedics and Traumatology, Faculty of Medicine, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey.
Background:
Segmental bone defects remain a major challenge in orthopedic surgery. The Masquelet's induced membrane technique (MIMT) is a two-stage reconstructive approach used for limb salvage in complex defects. This study evaluated radiographic healing and patient-reported outcomes after MIMT in a single tertiary center, including rare talus and metatarsal applications.
Methods:
We retrospectively reviewed 14 patients (10 males, 4 females) treated with MIMT for post-traumatic or osteomyelitis-related lower-extremity bone defects (tibia, femur, talus, metatarsal) between 2010 and 2023. Mean age was 35 ± 15.4 years and mean defect size was 8 ± 3.3 cm. Radiographic healing was assessed using the Lane and Sandhu scoring system. Patient-reported outcomes (SF-36 and LEFS) were collected at the final follow-up (mean 6 ± 4.5 years). Group comparisons and correlations were analyzed using t tests and Pearson correlation.
Results:
Union was achieved in 13/14 patients (93%), with a mean time to union of 11 ± 4.6 months. At the final follow-up, mean LEFS was 54 ± 15.7, mean MCS was 65.3 ± 6.5, and mean PCS was 35.3 ± 5.4. In exploratory analysis, male patients scored higher in SF-36 vitality and physical role limitation subdomains. No infection recurrence or amputation occurred. Longer inter-stage interval correlated with lower SF-36 mental health scores.
Conclusion:
In this small, retrospective, and heterogeneous cohort, MIMT was associated with a high observed union rate, durable infection control, and preserved mental health despite persistent physical limitations at the final follow-up. Rare-site talus and metatarsal reconstructions were feasible in this series, but inferences for these locations remain descriptive and hypothesis-generating given the limited case numbers.
Graphical Abstract:
This graphical abstract illustrates the two-stage of Masquelet's induced membrane technique (MIMT) for segmental bone defects. In the first stage, debridement, external fixation and insertion of a PMMA spacer induce a vascularized membrane around the defect. In the second stage, the spacer is removed and the membrane cavity is filled with cancellous bone graft, followed by stable plate fixation. Progressive callus formation leads to graft remodeling and restoration of bone continuity.