Figure 4.

Infected ankle nonunion and Masquelet technique. Radiographs of 25-year-old male 6 months after open reduction and internal fixation of a work-related grade II open bimalleolar ankle fracture demonstrating an infected nonunion (A and B). He had ongoing medial wound drainage despite a deep wound washout and prolonged antibiotic therapy. Postoperative radiographs 6 weeks after complete hardware removal, irrigation and debridement, and insertion of an antibiotic cement spacer as the first stage of the induced membrane (Masquelet) technique (C and D). He received 6 weeks of intravenous culture-specific antibiotics and his draining wound healed within 3 weeks of this procedure. Initial postoperative radiographs following removal of the cement spacer and ankle fusion with Iliac Crest bone graft and platelet-derived growth factor (PDGF, Augment, Wright Medical) insertion (E and F). Follow-up radiographs 1 year after the second stage procedure demonstrated solid union of the ankle fusion (G and H). The patient was able to return to work as a landscaper.