Figure 2

Clinical case combining the Masquelet-technique and the RIA-system to treat a tibial non-union. 51 year old male acquired a Gustillo 3B fracture of the right tibia and fibula and was treated with a stage procedure with locked plating and a free flap. The patient's progress was very slow and an implant failure occurred 8 months post-operatively (A). The patient was then referred for the further management and underwent debridement of the non-union site on the distal tibia by lifting the flap (B). The size of the extensive bone defect is shown in B (intraoperative image of situs and X-ray image with retractor in defect site). Additionally, a PMMA bone cement spacer was inserted into the tibial defect as part of the Masquelet technique. Postop X-ray images after surgery with the PMMA spacer (circles) in place (C). 8 weeks later the PMMA spacer was removed and the induced membrane at the defect site was packed with autologous cancellous bone graft obtained from the femur using the Reamer-Irrigator-Aspirator (RIA) technique. (D) shows assembled RIA system, insert showing morselised autologous bone and bone marrow graft obtained. Postop films after the second surgery (E). 7 weeks after bone grafting the defect showed good healing and patient was able to fully bear weight as tolerated. Over the following 2 months X-ray images showed progressive bridging of the zone and he was able to return to work with light duties. He was reviewed again 7 months post-surgery and had returned to work full-time and was walking long distances without any support (F).