Complex Right Distal Tibia Fracture with Bone Defect Managed Using Masquelet Technique and Ilizarov Fixation | Balanku Hospital

Advanced Limb Salvage & Reconstruction at Balanku Hospital

Severe open fractures of the tibia with bone loss and soft tissue damage are among the most challenging orthopedic injuries. These cases require staged surgical management, infection control, soft tissue reconstruction, and advanced bone regeneration techniques.

At Balanku Hospital, we specialize in complex trauma and limb salvage procedures. We are pleased to share the successful management of Mr. Sonu, who presented with a comminuted right distal one-third tibia fracture with Type 3B open wound, bone defect, and unstable ankle joint.

Understanding the Condition

Mr. Sonu presented with:

• Severe pain and deformity of the right leg

• Large open wound with exposed bone

• Bone loss (segmental defect)

• Unstable ankle joint

• Inability to bear weight

Clinical and radiological evaluation confirmed a Comminuted Right Distal 1/3 Tibia Fracture with Type 3B Open Wound and Bone Defect, a high-grade injury requiring staged reconstruction.

Such injuries demand a multidisciplinary approach to preserve the limb and restore function.

Stage 1: Initial Damage Control Surgery

Wound Debridement + External Fixator (Ex-Fix) Application

Emergency wound debridement was performed to remove contaminated and non-viable tissue. An external fixator (Ex-Fix) was applied to stabilize the fracture.

Masquelet Technique (Induced Membrane Technique)

Bone cement was placed in the defect area as part of the Masquelet Technique, which:

• Prevents soft tissue collapse into the defect

• Induces formation of a biological membrane

• Prepares the site for future bone reconstruction

A K-wire fixation was also done to stabilize the unstable ankle joint.

Stage 2: Soft Tissue Reconstruction

Due to significant soft tissue loss around the ankle, Mr. Sonu underwent Free Flap Coverage.

This procedure:

• Provided durable soft tissue coverage

• Protected exposed bone and implants

• Promoted wound healing

The flap healed well, ensuring a stable soft tissue envelope for further reconstruction.

Stage 3: Definitive Bone Reconstruction

Ilizarov Application with Corticotomy

In the next stage:

• The bone cement spacer was removed while preserving the induced membrane

• An Ilizarov ring fixator was applied

• Corticotomy was performed to initiate bone transport

Gradual distraction using the Ilizarov technique was carried out to regenerate new bone and fill the defect.

Key Benefits of Combined Approach

• Limb salvage in severe open fractures

• Biological bone regeneration

• Stable external fixation

• Preservation of induced membrane for healing

• Functional restoration of the limb

This staged approach combines modern trauma principles with advanced limb reconstruction techniques.

Procedure Overview

Current Status

• Flap has taken up well

• Ilizarov frame stable

• Gradual distraction in progress

• Limb alignment maintained

• Ongoing bone regeneration

Mr. Sonu is progressing well under close monitoring and structured rehabilitation.

Advanced Limb Reconstruction at Balanku Hospital

At Balanku Hospital, we are committed to:

• Managing severe open fractures with bone loss

• Performing Masquelet technique for bone defects

• Providing advanced Ilizarov limb reconstruction

• Delivering comprehensive wound and flap care

• Ensuring successful limb salvage and functional recovery

We take pride in restoring hope and mobility in complex trauma cases.