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The management of infected nonunion with bone loss is always challenging. The Masquelet technique is an excellent option available for us today. However, there are few reports of its use in the paediatric age group and no reports of its use especially in infected distal radius fractures or nonunion. We report on two children with infection and significant bone loss after open fractures of the distal radius which we have treated successfully using a modified Masquelet technique.

This case report describes the management of a 27-year-old male who, after a quadbike accident, presented with an open, infected, segmental both bone forearm injury with significant bone and soft tissue loss including the radio-carpal joint. Limb salvage was accomplished in the form of a single bone forearm fusion utilising Masquelet's two-stage induced membrane technique to reconstruct the segmental bone defect. The patient proceeded to uneventful bony union by 6 months and returned to driving and riding a quadbike. Despite significant deep infection, successful salvage was achieved using the induced membrane technique. Critical to success was aggressive, repeated debridement alongside restoration of vascular supply and reconstruction of soft tissue defects. We highlight the multidisciplinary approach to management including relevant specialists with a particular interest in limb reconstruction.

Reconstruction of post-traumatic large bone defect in tibia is a surgical challenge. Masquelet technique is a two stage procedure to achieve bone union. After cement spacer implantation in defect, optimal time for 2nd stage bone grafting is at 1 month. After 2 months, osteoinductive property of induced membrane is doubtful. We managed a post- traumatic tibial defect of 10 cm with cement spacer as 1st stage of Masquelet procedure. But 2nd stage was delayed for 6 months at which time osteoinductive property of induced membrane was doubtful. Osteopenia, pin track infection with stiff knee and ankle made 2nd stage surgery more challenging. We reconstructed 6 months old induced membrane with 12 cm non-vascularised fibula autograft in combination of cancellous autograft from iliac crest. The construct was fixed with locking compression plate on medial side. Patient achieved bone consolidation and successful union at 9 months with knee flexion of 100 degrees. This case demonstrated that induced membrane is able to preserve osteoinduction property even up to 6 months and with good structural support like fibula strut graft, successful reconstruction is possible in delayed 2nd stage of Masquelet technique.