Limb Salvage in Infected Tibial Nonunion with Bone Loss: A Case Report of a Modified Masquelet-Ilizarov Technique

Abstract

Gustilo-Anderson type III fractures, characterized by extensive soft-tissue damage, require urgent debridement and external fixation to minimize infection risk. Despite these measures, deep infections and osteomyelitis may still develop, sometimes leading to amputation. The Masquelet and Ilizarov techniques have emerged as effective approaches for reconstructing infected bone defects by promoting bone regeneration and soft-tissue healing. A 57-year-old male sustained a Gustilo-Anderson type IIIB open tibial-fibular fracture with severe soft-tissue injury in a traffic accident. Initial treatment included emergency debridement, external fixation, and vacuum sealing drainage (VSD). However, he developed a progressive infection with extensive soft-tissue necrosis and osteomyelitis. A modified Masquelet-Ilizarov technique was employed, involving necrotic bone resection, antibiotic cement spacer implantation, and subsequent bone transport using an Ilizarov frame. At final follow-up, satisfactory bone union and functional limb recovery were achieved.The combined Masquelet-Ilizarov technique offers a viable limb-salvage strategy for infected Gustilo-Anderson type IIIB tibial fractures with bone loss, yielding acceptable clinical and functional outcomes.