Morwood MP, et al. - Researchers compared the efficacy of intramedullary nail (IMN) vs plate fixation (PF) as a fixation method for treating critical bone defects with the induced membrane technique, also known as the Masquelet technique. They conducted the largest study to date assessing the Masquelet technique for critical-size defects in the femur and tibia. Among 121 patients with critical bone defects (56 tibias and 65 femurs) who were treated with the induced membrane technique, or Masquelet technique, IMN was used in 57 patients and plates in 64 patients. Outcomes indicated faster union, fewer grafting procedures, and fewer reoperations for all causes among patients treated with IMN vs those treated with plates, with differences more apparent in the femur. This seems to be due to both the development of an intramedullary canal and circumferential stress on the graft with early weight-bearing when employing an IMN, as opposed to a certain degree of stress shielding and delayed weight-bearing when using PF. Hence they recommend using an IMN whenever feasible as the preferred method of fixation for tibial and femoral defects when applying the Masquelet technique.