Posttraumatic segmental bone defects remains a challenge for the orthopaedic surgeon. These complex lesions are difficult to treat and lead to significant morbidity. The Masquelet technique was described for the treatment of large segmental bone defects and consists of a two-step procedure. In the first one after the debridement, a bone cement spacer was introduced in the bone defect followed by the reconstruction of the soft tissue. The polymethylmethacrylate (PMMA) spacer induces a foreign body reaction with the formation of a well vascularized membrane. In the second step, performed after six to eight weeks, the spacer was removed and the defect filled with bone graft. This video illustrates a case of a patient with an open fracture of the proximal third of the tibia with soft tissue injury and a complex fracture with segmental bone loss of 07cm, where the Masquelet technique was used.