06 September 2025
: Case report 
Salvage Masquelet Technique for Insufficient Bone Regeneration Following Chipping and Lengthening in Tibial Nonunion: A Case Report
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care
Jun Takagaki ABCDEF 1, Yohei Kumabe ABCDEF 1, Tomoaki Fukui BE 1, Ryosuke Kuroda E 1, Keisuke Oe ABDE 1*DOI: 10.12659/AJCR.948871
Am J Case Rep 2025; 26:e948871
Table 1 Surgical steps and outcomes.
| Step | Procedure | Timing | Implant/device | Outcome |
|---|---|---|---|---|
| Initial surgery | Chipping and lengthening technique using external fixator | Month 0 | Taylor spatial frame (Smith & Nephew) | Lengthening achieved (20 mm), deformity corrected |
| Conversion to internal fixation | Plate fixation after correction completion | Month 1 | Synthes LCP medial distal tibia plate | Partial maturation of regenerate, but central area showed delayed union |
| Assessment phase | Clinical and radiographic monitoring | Months 1–7 | Low-intensity pulsed ultrasound, patellar tendon-bearing brace | Insufficient consolidation of distraction callus at center |
| First-stage Masquelet immature procedure | Debridement of regenerate, insertion Month 7 of PMMA cement spacer | Cement spacer | No infection signs, induced membrane formation observed | |
| Second-stage Masquelet procedure | Cement removal, iliac crest cancellous bone grafting, plate replacement and lateral plate addition | Month 8 | Autologous iliac graft, bone regeneration smaller medial plate + lateral plate | Achieved |
| Final Outcome | Full weight-bearing without complications, radiographic union confirmed | Month 13 | – | Successful union, correction maintained, no implant-related complications |