Title : Treatment of infected tibial fracture in a cushing syndrome patient using ilizarov external fixator and autologous bone marrow grafting
Abstract:
This case report describes the surgical management of a female patient with multiple comorbidities—including Cushing’s syndrome, diabetes mellitus, hypertension, and osteoporosis—who sustained a right tibia and fibula metaphyseal fracture after a ground-level fall. Initially treated with internal osteosynthesis, the patient developed a postoperative wound infection caused by Pseudomonas aeruginosa, with soft tissue failure despite debridement and outpatient care.
A second surgery was performed to remove the infected hardware, followed by the application of a circular Ilizarov external fixator and local injection of autologous bone marrow aspirate from the tibial crest into the dehiscent area. This combination aimed to provide mechanical stabilization and promote bone and soft tissue healing via orthobiologic stimulation in a high-risk clinical setting.
This report highlights the complexity of treating infected fractures in immunosuppressed patients and the potential role of orthobiologics in enhancing recovery. The patient showed progressive healing, infection control, and satisfactory consolidation during outpatient follow-up.
Keywords: Tibial fracture, Cushing syndrome, Ilizarov, bone marrow aspirate, orthobiologics, infection
