The fate of stage I Masquelet cement spacers in long bone reconstruction for acute fractures.

INTRODUCTION: The Masquelet technique is widely used for reconstruction of segmental long bone defects following acute fractures; however, not all patients progress to the second-stage bone grafting procedure. The purpose of this study was to characterize Stage II completion following Stage I Masquelet cement spacer placement for acute long bone fractures, compare characteristics and outcomes between patients who underwent Stage I only versus completed Stage II reconstruction, and identify factors associated with progression to Stage II bone grafting.

METHODS: A retrospective review was conducted of adult patients who underwent Masquelet reconstruction for acute long bone fractures at a Level I trauma center between 2014 and 2024. Patients were stratified by completion of Stage II reconstruction. Demographic, injury-related, surgical, and clinical outcome variables were collected. Multivariable logistic regression was performed to identify factors independently associated with Stage II completion.

RESULTS: A total of 156 patients met inclusion criteria, of which 48 (30.8%) underwent Stage I only and 108 (69.2%) completed both stages. Patients who remained at Stage I underwent fewer orthopaedic operations (3.2 vs. 4.2, p = 0.001) and initial bony defect size did not differ between groups (84.1 vs. 78.8 mm, p = 0.423). Among patients with at least 6 months of follow-up, rates of fracture-related infection, hardware removal, wound dehiscence, amputation, and mortality were similar between groups. On multivariable analysis, no demographic or clinical variables were independently associated with Stage II completion.

CONCLUSION: Nearly one-third of patients undergoing the Masquelet technique for acute long bone fractures did not proceed to Stage II bone grafting. Amputation was the most common reason for not proceeding to Stage II; however, among patients with at least 6 months of follow-up, amputation rates did not differ significantly between groups. The inability to identify significant predictors of Stage II completion may reflect the multifactorial nature of progression through staged reconstruction, as well as limited statistical power in this cohort.