Reconstruction of a 20-cm tibial bone defect after recurrent fracture-related infection using the induced membrane technique and rhBMP-2 augmentation with limited autogenous bone availability: a case report

Abstract

Fracture-related infection (FRI) poses the combined challenges of infection control and reconstruction of critical-sized bone defects. These challenges are amplified in recurrent cases with severely limited autogenous bone availability. We report a 61-year-old male patient with recurrent right tibial FRI after multiple operations and a 20-cm segmental defect. Suspected residual infectious foci were mapped by comparing preoperative fluoro-deoxyglucose positron emission tomography/computed tomography (PET/CT) with post-debridement CT and were evaluated using site-specific pre-and post-debridement cultures. After a second targeted debridement, all post-debridement cultures were negative, and no clinical or laboratory evidence of active infection was observed during a 2-week antibiotic-free interval. The defect was subsequently reconstructed using the induced membrane technique with 30 cm³ of autogenous cancellous bone, 60 cm³ of de-mineralized bone matrix, and 9 mg of recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on a 20 cm³ hydroxyapatite carrier. Radiographic union was achieved, and no clinical evidence of infection recurrence was observed at 1 year. This case suggests the feasibility of combining PET/CT-and culture-guided anatomically targeted debridement with rhBMP-2-augmented induced membrane reconstruction when autogenous graft volume is severely limited.