Journal of Musculoskeletal Trauma

Reconstruction of a 20-cm tibial bone defect after recurrent fracture-related infection using the induced membrane technique and rhBMP-2 augmentation with limited autogenous bone availability: a case report: Whee Sung Son; Received March 30, 2026 Accepted June 29, 2026 Published online August 21, 2026; DOI: https://doi.org/10.12671/jmt.2026.00143 [Epub ahead of print]

Abstract PDF: Fracture-related infection (FRI) poses the combined challenges of infection control and reconstruction of critical-sized bone defects. These challenges are amplified in recurrent cases with severely limited autogenous bone availability. We report a 61-year-old male patient with recurrent right tibial FRI after multiple operations and a 20-cm segmental defect. Suspected residual infectious foci were mapped by comparing preoperative fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) with post-debridement CT and were evaluated using site-specific pre- and post-debridement cultures. After a second targeted debridement, all post-debridement cultures were negative, and no clinical or laboratory evidence of active infection was observed during a 2-week antibiotic-free interval. The defect was subsequently reconstructed using the induced membrane technique with 30 cm³ of autogenous cancellous bone, 60 cm³ of demineralized bone matrix, and 9 mg of recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered on a 20 cm³ hydroxyapatite carrier. Radiographic union was achieved, and no clinical evidence of infection recurrence was observed at 1 year. This case suggests the feasibility of combining PET/CT- and culture-guided anatomically targeted debridement with rhBMP-2-augmented induced membrane reconstruction when autogenous graft volume is severely limited. Level of evidence: V.

Open distal radius fracture with ulnar neurovascular injury treated with dorsal spanning plate fixation and vein interposition grafting: a case report: Kyeong-Eon Kim, Ho-Yong Lee, Shin-Woo Lee, Ji-Sup Kim; J Musculoskelet Trauma 2026;39(3):262-268. Published online July 20, 2026; DOI: https://doi.org/10.12671/jmt.2026.00164

Abstract PDF: Open comminuted intra-articular distal radius fractures with associated ulnar neurovascular injury are rare; furthermore, these injuries are challenging because skeletal stabilization, arterial reconstruction, nerve assessment, and soft-tissue coverage must be coordinated. We report the case of an 80-year-old female patient who presented after a fall from stairway with a severe open distal radius fracture and a volar-ulnar distal forearm wound. She reported numbness and tingling in the ring and small fingers, with a cold sensation and delayed capillary refill. Imaging showed a severely comminuted intra-articular distal radius fracture (AO/OTA type 23-C3). Emergency surgery was performed within 6 hours. First, a dorsal spanning plate was applied, and the small volar lunate facet fragment was fixed with a volar lunate facet plate. After debridement of the injured ulnar artery, a segmental defect remained and was reconstructed using a reversed basilic vein interposition graft harvested from the ipsilateral proximal forearm. The contused but continuous ulnar nerve was treated with neurolysis. The soft-tissue defect was managed with an acellular dermal matrix and negative-pressure wound therapy, followed by staged full-thickness skin grafting 1 week later. At 1 year postoperatively, bony union was achieved, and the functional outcomes were satisfactory. Level of evidence: V.

Fixation with two headless compression screws and a distal-radius bone graft for proximal scaphoid nonunion with dorsal intercalated segment instability deformity: a report of three cases: Seonjeong Lee, Won Sun Lee, Jae Kwang Kim; J Musculoskelet Trauma 2026;39(3):252-261. Published online July 7, 2026; DOI: https://doi.org/10.12671/jmt.2026.00136

Abstract PDF: Proximal scaphoid nonunion is difficult to treat because the proximal fragment is small and biologically compromised. Secure fixation can be especially challenging when dorsal intercalated segment instability (DISI) is present and requires correction. We report three male patients with proximal scaphoid nonunion and DISI deformity who underwent volar fixation with two 2.4-mm headless compression screws and cancellous bone graft harvested from the distal radius at the Lister tubercle. Preoperative computed tomography confirmed a proximal nonunion line and proximal fragment dimensions considered sufficient for dual-screw fixation, and magnetic resonance imaging showed no definite avascular necrosis. Early postoperative computed tomography showed maintained fixation and alignment in all three patients. Although CT-confirmed union at final follow-up was not uniformly available, radiographic union defined on plain radiographs was achieved in all cases without loss of alignment or carpal collapse. Carpal alignment improved in two patients, but DISI persisted in one. One patient underwent secondary removal of a preexisting loose body and one screw. This small case series suggests that dual-screw fixation with cancellous grafting may be technically feasible in selected proximal scaphoid nonunions with concomitant DISI. Level of evidence: V.

Radiocarpal subluxation after volar plating due to an insufficiently supported dorsal key fragment: a case report: Yeongyoon Koh, Kanghun Yu, Jong Woong Park, In Cheul Choi; J Musculoskelet Trauma 2026;39(3):269-274. Published online July 3, 2026; DOI: https://doi.org/10.12671/jmt.2026.00185

Abstract PDF: Distal radius fractures are commonly managed using volar locking plate fixation, which provides stable fixation in most cases. However, certain fracture patterns involving dorsal key fragments may not be adequately stabilized with a volar approach alone, even when intraoperative reduction appears satisfactory. We report the case of a 58-year-old male patient with a complex intra-articular distal radius fracture involving a dorsoulnar corner (DUC) fragment. Preoperative computed tomography revealed a dorsal fragment associated with subtle dorsal radiocarpal subluxation. Despite this finding, the fragment was considered amenable to fixation through a volar approach because it was relatively large. Although satisfactory reduction was achieved intraoperatively, early postoperative imaging demonstrated progressive dorsal radiocarpal subluxation due to displacement of the DUC fragment, while overall alignment parameters remained preserved. Revision surgery with additional dorsal buttress fixation successfully restored stability. This case highlights the critical importance of recognizing dorsal key fragments and achieving adequate dorsal support during fixation, as failure to provide sufficient support may result in delayed instability despite acceptable initial reduction. Level of evidence: V.

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