Masquelet technique with external locking plate for recalcitrant distal tibial nonunion

Objective: In the present retrospective study, we aimed to analyze the results of treatment for recalcitrant distal tibial nonunion using Masquelet technique with locking plate as a definitive external fixator. Materials: We included 15 consecutive cases of distal tibial nonunion treated at our hospital between January 2012 and December 2015. The reconstructive procedure comprised debridement of the nonunion site, deformity correction, stabilization with an external locked plate, defect filling with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique). All patients were followed-up for at least one year. Results: Fracture union occurred in all cases after a median of 6.5 months (range, 5–12 months). Mean ankle motion ranged from 12.3 (range, 5–20) degrees of dorsiflexion to 35 (range, 5–55) degrees of plantar flexion. At the final follow-up, the median Iowa ankle score was 83 (range, 68–91). Eight patients had excellent scores, six had good scores, and one had fail score. Conclusion: Although the current study involved only a small number of patients and the intervention comprised two stages, we consider that the used protocol is a simple and valuable alternative for the treatment of recalcitrant distal tibial nonunion.