Liquid nitrogen-treated recycled autograft for reconstruction of a large tibial defect following wide resection of adamantinoma: a case report

Introduction and importance: Adamantinoma is a rare, low-grade malignant bone tumor with a predilection for the tibial diaphysis. Wide resection is the standard treatment, but reconstruction of large segmental tibial defects remains technically challenging. Liquid nitrogen-treated recycled autografts offer biological reconstruction, though experience with adamantinoma is extremely limited. Case presentation: A 36-year-old male presented with a 6-month history of progressive left tibial pain and swelling. Imaging revealed a 20-cm expansile osteolytic mid-diaphyseal lesion, confirmed histologically as adamantinoma. He underwent wide resection of a 25-cm tibial segment with liquid nitrogen devitalization (20-minute freezing at −196°C, 15-minute thawing, and 15-minute washing), followed by reimplantation with combined intramedullary nail and plate fixation, bone cement augmentation, autologous iliac crest grafting, and gastrocnemius flap coverage. Clinical discussion: Only two prior cases of LN2-treated recycled autograft for adamantinoma have been reported. This case demonstrates consistent outcomes and highlights the role of combined fixation, cement augmentation, and vascularized soft tissue coverage in achieving union over a 25-cm defect. Conclusion: Liquid nitrogen-treated recycled autograft with rigid fixation, cement augmentation, and vascularized soft tissue coverage achieves satisfactory oncological and functional outcomes in tibial adamantinoma. Lifelong surveillance remains mandatory.