What to do in infected tibial nonunion when distraction osteogenesis, Mascale or vascularized bone graft is not possible?

Not all science is randomized trials. Some conditions are really rare and in those you can mostly rely on clinical experience. This was exactly the case my colleague had. He had a patient who had undergone a bicondylar plating of severely comminuted proximal tibia fracture. Deep infection resulted to a massive bone loss which lead to a situation where joint surface and subchondral bone was basically floating above an empty space.

Distraction osteogenesis, Mascale procedure or vascularized bone graft was not possible and tumor endoprosthesis was deemed too risky considering the infection. Eventually this patient was treated with a “cemented wires technique” which turned out to be a good solution for the patient. To best of our knowledge this has not been reported earlier in the literature.

We describe this case in our JBJS Case Connector article “Polymethyl Methacrylate Cement Fill as a Definitive Treatment for Massive Bone Defect After Infected Internal Fixation in Bicondylar Tibial Fracture: A Case Report“.

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