Biomimetic Hematoma Enables Healing in a Recalcitrant Nonunion With Chronic Osteomyelitis and 20 Prior Surgeries A Case Report

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Abstract

Case: A 49-year-old male smoker with no comorbidities presented with a tibial plafond fracture treated operatively. Complications resulted to an infected nonunion, requiring 20 surgeries over 3 years. Examination revealed a malaligned hypertrophic nonunion with osteomyelitis requiring extensive reconstruction. Deformity was corrected with a Taylor Spatial Frame, followed by the implantation of a biomimetic hematoma scaffold delivering recombinant human bone morphogenetic protein-2 (rhBMP-2) into the debrided defect, alongside Cerement G to control infection. At 6 months, the patient achieved complete bony union without recurrence of infection, allowing Taylor Spatial Frame removal. Conclusion: The biomimetic hematoma enabled successful healing using a low-dose rhBMP-2, highlighting its potential for treatment-resistant nonunions.

Original languageEnglish (US)
Article numbere25.00267
JournalJBJS Case Connector
Volume15
Issue number3
DOIs
StatePublished - 2025

Keywords

  • CERAMENT G
  • Gram-negative bacteria
  • Gram-positive bacteria
  • ORIF, TSF
  • S. aureus
  • biomimetic hematoma
  • bone graft
  • bone healing
  • infection
  • male
  • nonunion
  • osteomyelitis
  • rhBMP-2
  • scaffold
  • tibial plafond fracture

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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