Biomimetic Hematoma Enables Healing in a Recalcitrant Nonunion With Chronic Osteomyelitis and 20 Prior Surgeries

A 49-year-old male smoker with no comorbidities presented with a tibial plafond fracture treated operatively. Complications resulted to an infected nonunion, requiring 20 surgeries over 3 years. Examination revealed a malaligned hypertrophic nonunion with osteomyelitis requiring extensive reconstruction. Deformity was corrected with a Taylor Spatial Frame, followed by the implantation of a biomimetic hematoma scaffold delivering recombinant human bone morphogenetic protein-2 (rhBMP-2) into the debrided defect, alongside Cerement G to control infection. At 6 months, the patient achieved complete bony union without recurrence of infection, allowing Taylor Spatial Frame removal. The biomimetic hematoma enabled successful healing using a low-dose rhBMP-2, highlighting its potential for treatment-resistant nonunions.