Combination of a free vascularised fibula and the Masquelet technique for long bone ulna defect reconstruction: A case report

We present a case of spontaneous osteomyelitis of the left ulna in a 25-year-old man. There was no history of trauma or haematogenous source identified. Bone biopsy found staphylococcus aureus on culture, sensitive to flucloxacillin, but antibiotic treatment was unsuccessful. He underwent excision of the osteomyelitic ulna and a vascularised free fibula graft (VFF graft) reconstruction of the bony defect (18 cm in length), using the ulnar artery at the wrist as recipient vessel. Six months later he was found to have radiological evidence of bony resorption at the proximal fibula-ulnar junction. He underwent resection of a 5 cm segment of the fibula flap and insertion of an antibiotic-impregnated cement spacer in preparation for the placement of bone graft as per Masquelet technique. Following bone graft placement, he united 4 months later. This case demonstrates that the Masquelet technique can be used successfully as an adjunct to VFF graft when reconstructing very long bony defects.