Custom 3D-Printed Tibial Reconstruction for Pathological Fracture Secondary to Chronic Osteomyelitis

Patient overview

A 12-year-old female presented with pain over the left leg, inability to walk and intermittent fever.

She had previously been treated in Yemen for a suspected soft-tissue infection, undergoing three debridement procedures followed by intravenous antibiotic therapy at a local hospital. On examination, a healed surgical scar was noted with approximately 2 cm of shortening in the affected limb.

She was diagnosed with a pathological fracture of the tibial shaft secondary to chronic osteomyelitis. MRI and blood investigations were performed to assess the extent of infection and bone involvement.

Stage 1 — infection control and bone preparation

The first stage addressed the infection before any reconstruction could be considered:

• Extensive debridement and sequestrectomy to remove infected and non-viable bone.
• A cement spacer to manage the infected bone defect.
• Intraoperative samples taken for microbiological and culture analysis, with resected bone sent for histopathological examination.
• Discharge on culture-specific intravenous antibiotics with an above-knee slab.
• ESR and CRP monitored at regular intervals to assess the response to infection control.

Patient-specific surgical planning

With the infection controlled, planning turned to the definitive reconstruction. A CT-based 3D assessment established the extent of bone loss and what the reconstruction would need to restore.

From the patient’s own anatomy and the segmental defect:

• A custom intramedullary nail was designed specifically for her, with measurements taken from the extent of bone loss and the anatomical requirements.
• A patient-specific PEKK graft was designed and manufactured by Oxford Performance Materials, USA.
• The components were planned together to bridge the tibial defect and provide structural support.

Stage 2 was scheduled once the customised implants were available.

Stage 2 — patient-specific tibial reconstruction

The definitive procedure combined spacer removal with fixation using the custom nail, the PEKK graft, autologous fibula grafting and soft-tissue reconstruction. The defect was bridged with:

• A porous TiCellium 3D-printed custom nail
• The patient-specific PEKK implant
• An autologous fibula graft
• Locking fixation
• Soft-tissue reconstruction

Together these hybrid components were designed to bridge the defect, restore structural continuity of the tibia and provide stable fixation while incorporating biological bone grafting.

Custom 3D-printed reconstruction

The reconstruction was developed from the patient’s CT anatomy and the specific characteristics of the tibial defect.

Key features: a custom nail matched to the patient’s anatomy and length; a porous TiCellium structure to support biological integration; a PEKK graft sized to the measured bone defect; an autologous fibula graft for biological reconstruction; locking fixation for mechanical stability; and integrated planning that addressed both the 2 cm shortening and the segmental bone loss.

Clinical impact

This case demonstrates the role of patient-specific 3D-printed implants and advanced digital planning in complex paediatric limb reconstruction following chronic osteomyelitis and pathological fracture.

Combining CT-based surgical planning, custom 3D-printed TiCellium technology, PEKK reconstruction, autologous fibula grafting and customised fixation produced a highly individualised hybrid strategy for a challenging tibial defect.

The case highlights how personalised implant design can support complex reconstruction where conventional options may be insufficient for the patient’s anatomy and the extent of bone loss.