Journal of Musculoskeletal Trauma

Case Report

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.

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Original Articles

Limb Salvage versus Early Amputation according to Mangled Extremity Severity Score in Treatment of the Lower Extremity Open Fractures associated with Severe Soft Tissue Injury: Kyung Jin Song, Yong Min Kim, Kyung Rae Lee; J Korean Soc Fract 2002;15(1):28-35. Published online January 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.1.28

Abstract PDF: PURPOSE
To evaluate the availability of the mangled extremity severity score(MESS) in deciding the early treatment modality for the patients with open lower extremity fractures and severe soft tissue injury.
MATERIALS AND METHODS
Analyzed 27 patients for the lower extremity open fractures with extensive soft tissue injury. A comparative study using a MESS, a cause of injury, vascular injury and a fracture pattern, average hospital stay and average hospital charges were analyzed, and daily living ability and subjective self-evaluation were assessed.
RESULTS
There was statistically significant correlation applying MESS to patient group that had been operated by early amputation because of severe soft tissue and vascular injury. But there was no significant difference in the subjective self-assessment score, admission period and total cost during admission between each treatment method.
CONCLUSION
MESS can be used as an objective assessment criteria in deciding the proper treatment modality for the cases of lower limbs fracture with extensive soft tissues and vascular injury.

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Arterial Injuries associated with Fractures or Dislocations around the Knee: Chang Wug Oh, Joo Chul Ihn, Byung Chul Park, Il Hyung Park, Shin Yoon Kim, Hee Soo Kim; J Korean Soc Fract 1999;12(4):865-871. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.865

Abstract PDF: The purpose of this article is to delineate factors important in successful management and subsequent extremity function of the patient with arterial injury associated with fractures or dislocations around the knee. We reviewed 25 cases of arterial injury associated with fractures or dislocations around the knee which were treated at our hospital between 1994 and 1998. As long term results, the salvage rate of the lower limb was related to the extent of the soft tissue damage and the severity of infection, but there was no statistical difference according to the method of vascular surgery(p=0.645). Compared with the salvage rate of the lower limb according to the length of time from injury to vascular reanastomosis, there was no statistical difference between two groups of the patients who were operated within 12 hours and were operated during the time between 12 hours and 24 hours(p=0.084). In view of whether open or closed fractures were combined, 1 I cases(58%) among 19 cases of open fractures and 5 cases(83%) among S cases of close(1 fractures were able to salvage the lower limb, so it could contributes to the sdlvdge rate of the limb. Finally 16 cases(64%) among total 25 cases were able to salvage the lower limb, and its functional outcome was like followings : excellent results were found in 6 cases, fair results in 8 cases, poor results in 2 cases, and amputation in 9 cases(36%). In case of amputation, 3 cases were primarily amputated and 6 cases were amputated secondary to vascular surgery . As long term results, whether open or closed fractures were combined, the teverity of the infection and the extent of the soft tissue necrosis were the factors influencing on the falvage rate of the lower limb. Other factors, such as the difference of ischemic time within 24 hours interval, the site and the method of management of the fractures and the vascular injuries and whether fasciotomy was performed or not were not important factors influencing on the salvage rate of the lower limb.

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