Surgeons successfully reconstructed an extensive 17-centimeter segmental femoral bone defect in a 22-year-old male patient using a customized 3D-printed microporous titanium alloy scaffold combined with a free vascularized fibular flap, according to a case report published in BMC Musculoskeletal Disorders.

The patient presented with haematogenous osteomyelitis involving the left tibia (classified as Cierny–Mader type III) and the left femur (Cierny–Mader type IV), complicated by a pathological femoral fracture. Following extensive debridement, significant bone loss remained, including a 13-centimeter anterolateral cortical defect in the tibia and the 17-centimeter segmental gap in the femoral shaft. Staged treatment initially employed antibiotic-loaded cement spacers and internal fixation, with the tibial defect subsequently reconstructed using the Masquelet technique and autologous bone grafting.

Persistent infection in the femur required repeated debridement procedures, delaying definitive femoral reconstruction. The surgical team decided to proceed with reconstruction after intraoperative frozen-section histopathology revealed fewer than five neutrophils per high-power field, despite previously elevated inflammatory markers. The defect was reconstructed using the customized 3D-printed microporous titanium alloy scaffold alongside a free vascularized fibular flap, supplemented by autologous cancellous bone grafting and anatomical locking plate fixation.

At the three-year follow-up, osseous union was documented at the fibular graft–host bone interfaces, with no clinically evident recurrence of infection or implant failure. The patient returned to work and achieved a Lower Extremity Functional Scale score of 71/80. The authors noted that while the scaffold provided initial structural support and the flap provided biological reinforcement, further studies are required to determine the safety, reproducibility, and long-term effectiveness of this combined approach.

Subject of Research: Femoral segmental bone defect reconstruction using 3D-printed titanium scaffolds and fibular flaps

Article Title: Reconstruction of an extensive infection-related femoral segmental bone defect using a customized 3D-printed porous titanium scaffold and a free vascularized fibular flap: a case report and literature review

Article References: Yu, X., Liu, Y., Su, D., Liang, Z., Cao, D., Li, S., Li, L., Wei, A., Tang, X., Zhang, X., Zhang, X., & Wang, Z. (2026). Reconstruction of an extensive infection-related femoral segmental bone defect using a customized 3D-printed porous titanium scaffold and a free vascularized fibular flap: a case report and literature review. BMC Musculoskeletal Disorders. https://doi.org/10.1186/s12891-026-10686-3

Image Credits: AI Generated

DOI: 10.1186/s12891-026-10686-3

Keywords: osteomyelitis, femoral defect, case report, 3D-printed scaffold, titanium alloy, fibular flap, bone reconstruction, orthopedic surgery, Reconstruction, extensive, infection-related, femoral