Combined application of antibiotic bone cement and bone transport technique in tibial osteomyelitis with bone defect

Rationale: Management of post-traumatic tibial osteomyelitis accompanied by substantial segmental bone defects (>5 cm) presents a formidable clinical challenge, primarily due to biofilm-associated persistent infections and the inherent complexities of bone regeneration. Single-stage interventions are often insufficient for such complex lesions. This case report demonstrates the value of a staged protocol integrating antibiotic-loaded bone cement (ALBC) with bone transport, which sequentially addresses infection and mechanical bone discontinuity. Patient concerns: A 54-year-old male presented with chronic tibial osteomyelitis and a 6 cm segmental bone defect following internal fixation for an open fracture. Diagnoses: Post-traumatic chronic tibial osteomyelitis with a 6 cm segmental tibial bone defect. Interventions: Staged surgical management was adopted. The first stage included radical debridement, implant removal, infected bone resection, ALBC spacer implantation, and external fixation. After a 3-month interval for infection eradication, the second-stage surgery was performed, consisting of cement removal, antibiotic-impregnated calcium sulfate implantation, and bone transport via distraction osteogenesis at 1 mm/day. Autologous iliac bone grafting was utilized to achieve docking-site union. Outcomes: Final bony union was achieved at the docking site. Lessons: This staged approach combining ALBC with bone transport is a viable strategy for complex tibial osteomyelitis with large bone defects. ALBC first creates a sterile and mechanically stable environment, which serves as a critical prerequisite for the success of subsequent reconstructive bone-transport procedures.