Incidental use of polymethylmethacrylate as a bone substitute in managing critical bone loss following grade IIIB open tibial fracture – A case report

Background Grade IIIB open tibial fractures are a severe form of open fractures usually accompanied by soft tissue loss and bone loss, which can be challenging to manage, and are associated with increased risk of complications, especially fracture-related infection. Popular management strategies include the induced membrane technique (Masquelet) and the distraction histogenesis technique by Ilizarov. These strategies are not, however, without their own challenges. Hence, a simple and inexpensive method of managing the bone loss usually found to accompany these fractures would revolutionize trauma care. Case report A 54-year-old patient presented with Gustilo-Anderson type IIIB open fracture of the left leg with approximately 14 cm bone loss. He was managed by fixing the fracture with an antibiotic cement-coated plate and by the use of a polymethylmethacrylate (PMMA) spacer to fill the bone defect with a plan for a second-stage Masquelet technique. The bone spacer was not removed due to delays in accessing theatre space, and subsequent clinical and radiological images showed evidence of fracture union without features of fracture-related infection. Conclusion This case report highlights the possibility of using PMMA as a bone substitute and also for preventing fracture-related infection in severe open fractures.