Modified Masquelet Technique for First Metatarsal Salvage in a 14-Year-Old With Chronic Osteomyelitis: A Case Report.

CASE: A 14-year-old boy developed chronic first-metatarsal osteomyelitis and was left with a 4-cm defect after thorough debridement. Initial management included radical excision, insertion of a gentamicin polymethyl-methacrylate spacer supplemented with vancomycin and application of a mini external fixator to preserve length and alignment. After normalization of inflammatory markers, the second stage used induced-membrane preservation with reconstruction using a nonvascularized fibular strut graft, cancellous iliac crest graft, and low-profile plate fixation, achieving union and full functional recovery. CONCLUSION: A modified Masquelet approach with temporary external fixation and structural fibular grafting offers a viable limb-salvage solution for pediatric first-metatarsal osteomyelitis.