{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:41:22Z","timestamp":1787755282440,"version":"build-2784847793"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Case:<\/jats:title>\n                    <jats:p>An 80-year-old women with multiple comorbidities and a history of revision total knee arthroplasty presented with a periprosthetic tibial nonunion and severe varus deformity. She underwent dual-plate fixation with a biomimetic hematoma (BH) scaffold delivering recombinant human bone morphogenetic protein-2 (rhBMP-2) to manage oligotrophic nonunion. Radiographs confirmed complete union at 4 months. Following surgery and tirzepatide initiation, she progressed from wheelchair dependence to full weight bearing with walker assistance at 1 year, achieving a 75-pound weight loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The BH delivering low-dose rhBMP-2 enabled successful bone healing and functional recovery in a medically complex patient, highlighting its potential in the treatment of challenging periprosthetic nonunions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.cc.26.00065","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T18:00:47Z","timestamp":1780682447000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Biomimetic Hematoma Enables Healing in Complex Periprosthetic Fracture Nonunion with Multiple Comorbidities"],"prefix":"10.2106","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3405-2471","authenticated-orcid":false,"given":"Adam","family":"Maestas","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9625-8078","authenticated-orcid":false,"given":"Vaida","family":"Glatt","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas"},{"name":"Sam and Ann Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1026-9785","authenticated-orcid":false,"given":"Joseph F.","family":"Alderete","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Texas Health Science Center San Antonio, San Antonio, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4]]},"reference":[{"key":"bib1-20260605","doi-asserted-by":"crossref","first-page":"21514593211023996","DOI":"10.1177\/21514593211023996","article-title":"Current reconstruction options in periprosthetic fractures around the knee","volume":"12","author":"Cacciola","year":"2021","journal-title":"Geriatr Orthop Surg Rehabil."},{"issue":"1 suppl","key":"bib2-20260605","first-page":"e241","article-title":"Managing periprosthetic tibia fractures: international perspectives","volume":"6","author":"Lewis","year":"2023","journal-title":"OTA Int."},{"issue":"2","key":"bib3-20260605","first-page":"33772","article-title":"Periprosthetic knee fractures in an elderly population: open reduction and internal fixation vs distal femur megaprostheses","volume":"14","author":"De Marco","year":"2022","journal-title":"Orthop Rev (Pavia)."},{"issue":"4","key":"bib4-20260605","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.injury.2019.03.014","article-title":"Outcomes of fixation for periprosthetic tibia fractures around and below total knee arthroplasty","volume":"50","author":"Morwood","year":"2019","journal-title":"Injury."},{"issue":"10","key":"bib5-20260605","doi-asserted-by":"crossref","first-page":"3287","DOI":"10.1007\/s00167-020-06154-7","article-title":"The projected volume of primary and revision total knee arthroplasty will place an immense burden on future health care systems over the next 30 years","volume":"29","author":"Klug","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"9","key":"bib6-20260605","doi-asserted-by":"crossref","first-page":"3228","DOI":"10.1002\/ksa.12692","article-title":"Periprosthetic fractures of the tibia in knee arthroplasty have a high risk of treatment failure: a systematic review","volume":"33","author":"Kalifis","year":"2025","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"issue":"suppl 2","key":"bib7-20260605","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1016\/j.injury.2020.11.029","article-title":"Fracture nonunion in long bones: a literature review of risk factors and surgical management","volume":"52","author":"Nicholson","year":"2021","journal-title":"Injury."},{"issue":"2","key":"bib8-20260605","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.otsr.2016.10.007","article-title":"Successful outcome with minimally invasive plate osteosynthesis for periprosthetic tibial fracture after total knee arthroplasty","volume":"103","author":"Kim","year":"2017","journal-title":"Orthop Traumatol Surg Res."},{"key":"bib9-20260605","doi-asserted-by":"crossref","first-page":"101892","DOI":"10.1016\/j.jcot.2022.101892","article-title":"Tibial periprosthetic fractures in total knee arthroplasty - a scoping review","volume":"29","author":"Shukla","year":"2022","journal-title":"J Clin Orthop Trauma."},{"issue":"1","key":"bib10-20260605","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1186\/s12891-016-1312-4","article-title":"Autologous bone graft in the treatment of post-traumatic bone defects: a systematic review and meta-analysis","volume":"17","author":"Azi","year":"2016","journal-title":"BMC Musculoskelet Disord."},{"issue":"4","key":"bib11-20260605","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1097\/BOT.0000000000001420","article-title":"Autograft, allograft, and bone graft substitutes: clinical evidence and indications for use in the setting of orthopaedic trauma surgery","volume":"33","author":"Baldwin","year":"2019","journal-title":"J Orthop Trauma."},{"issue":"1 suppl A","key":"bib12-20260605","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1302\/0301-620X.98B.36350","article-title":"Bone grafts and their substitutes","volume":"98-B","author":"Fillingham","year":"2016","journal-title":"Bone Joint J."},{"issue":"10","key":"bib13-20260605","doi-asserted-by":"crossref","first-page":"2893","DOI":"10.3390\/ijms19102893","article-title":"Cellular mechanisms responsible for success and failure of bone substitute materials","volume":"19","author":"Rolvien","year":"2018","journal-title":"Int J Mol Sci."},{"issue":"1","key":"bib14-20260605","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00264-020-04876-4","article-title":"Onlay fibula autografting technique and its comparison with cortical allograft for the reconstruction of periprosthetic bone defects around the femur","volume":"45","author":"Tuncay","year":"2021","journal-title":"Int Orthop."},{"issue":"1","key":"bib15-20260605","doi-asserted-by":"crossref","first-page":"9098","DOI":"10.1038\/s41598-022-12140-5","article-title":"Union, complication, reintervention and failure rates of surgical techniques for large diaphyseal defects: a systematic review and meta-analysis","volume":"12","author":"Feltri","year":"2022","journal-title":"Sci Rep."},{"key":"bib16-20260605","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1749-799X-8-33","article-title":"Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients","volume":"8","author":"Flierl","year":"2013","journal-title":"J Orthop Surg Res."},{"issue":"6","key":"bib17-20260605","doi-asserted-by":"crossref","first-page":"103896","DOI":"10.1016\/j.otsr.2024.103896","article-title":"A systematic scoping review of the latest data on orthobiologics in the surgical treatment of non-union","volume":"110","author":"Gagnon","year":"2024","journal-title":"Orthop Traumatol Surg Res."},{"issue":"4","key":"bib18-20260605","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1089\/ten.teb.2015.0357","article-title":"A review of the clinical side effects of bone morphogenetic protein-2","volume":"22","author":"James","year":"2016","journal-title":"Tissue Eng Part B Rev."},{"key":"bib19-20260605","doi-asserted-by":"crossref","first-page":"110805","DOI":"10.1016\/j.compositesb.2023.110805","article-title":"Advances in the application of bone morphogenetic proteins and their derived peptides in bone defect repair","volume":"262","author":"Liu","year":"2023","journal-title":"Compos B Eng."},{"issue":"6","key":"bib20-20260605","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.spinee.2011.04.023","article-title":"A critical review of recombinant human bone morphogenetic protein-2 trials in spinal surgery: emerging safety concerns and lessons learned","volume":"11","author":"Carragee","year":"2011","journal-title":"Spine J."},{"issue":"9","key":"bib21-20260605","doi-asserted-by":"crossref","first-page":"313","DOI":"10.3390\/jfb16090313","article-title":"A critical review of commercial collagen-based scaffolds in bone regeneration: functional properties and clinical evidence from Infuse((R)) bone graft","volume":"16","author":"Karipidou","year":"2025","journal-title":"J Funct Biomater."},{"issue":"5","key":"bib22-20260605","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1007\/s11999-012-2684-x","article-title":"Adverse events after recombinant human BMP2 in nonspinal orthopaedic procedures","volume":"471","author":"Woo","year":"2013","journal-title":"Clin Orthop Relat Res."},{"issue":"10","key":"bib23-20260605","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.1002\/jbmr.4107","article-title":"Recombinant human BMP6 applied within autologous blood coagulum accelerates bone healing: randomized controlled trial in high tibial osteotomy patients","volume":"35","author":"Chiari","year":"2020","journal-title":"J Bone Miner Res."},{"key":"bib24-20260605","doi-asserted-by":"crossref","DOI":"10.1097\/BOT.0000000000003165","article-title":"Biomimetic hematoma promotes superior bone regeneration with ultra-low dose rhBMP-2 in a goat large defect model","author":"Glatt","year":"2026","journal-title":"J Orthop Trauma."},{"issue":"11S","key":"bib25-20260605","doi-asserted-by":"crossref","first-page":"S33","DOI":"10.1097\/BOT.0000000000002692","article-title":"Biomimetic hematoma as a novel delivery vehicle for rhBMP-2 to potentiate the healing of nonunions and bone defects","volume":"37","author":"Glatt","year":"2023","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib26-20260605","doi-asserted-by":"crossref","first-page":"e25.00267","DOI":"10.2106\/JBJS.CC.25.00267","article-title":"Biomimetic hematoma enables healing in a recalcitrant nonunion with chronic osteomyelitis and 20 prior surgeries: a case report","volume":"15","author":"Maestas","year":"2025","journal-title":"JBJS Case Connect."},{"key":"bib27-20260605","doi-asserted-by":"crossref","first-page":"213366","DOI":"10.1016\/j.bioadv.2023.213366","article-title":"Biomimetic hematoma delivers an ultra-low dose of rhBMP-2 to successfully regenerate large femoral bone defects in rats","volume":"148","author":"Woloszyk","year":"2023","journal-title":"Biomater Adv."},{"key":"bib28-20260605","doi-asserted-by":"crossref","first-page":"115551","DOI":"10.1016\/j.bone.2020.115551","article-title":"A novel autologous bone graft substitute comprised of rhBMP6 blood coagulum as carrier tested in a randomized and controlled phase I trial in patients with distal radial fractures","volume":"140","author":"Durdevic","year":"2020","journal-title":"Bone."},{"issue":"7","key":"bib29-20260605","doi-asserted-by":"crossref","first-page":"3053","DOI":"10.1007\/s00402-024-05410-6","article-title":"Equal rates of bone healing and reduced surgical time with iliac crest allograft compared to autograft in medial opening wedge high tibial osteotomy: a randomized controlled clinical trial","volume":"144","author":"de Paula","year":"2024","journal-title":"Arch Orthop Trauma Surg."},{"issue":"4","key":"bib30-20260605","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1177\/0363546507312646","article-title":"Union of medial opening-wedge high tibial osteotomy using a corticocancellous proximal tibial wedge allograft","volume":"36","author":"Yacobucci","year":"2008","journal-title":"Am J Sports Med."},{"issue":"19","key":"bib31-20260605","doi-asserted-by":"crossref","first-page":"4597","DOI":"10.3390\/jcm10194597","article-title":"Effect of bone morphogenetic Protein-2 in the treatment of long bone non-unions","volume":"10","author":"Fuchs","year":"2021","journal-title":"J Clin Med."},{"issue":"12","key":"bib32-20260605","doi-asserted-by":"crossref","first-page":"2123","DOI":"10.2106\/00004623-200212000-00001","article-title":"Recombinant human bone morphogenetic protein-2 for treatment of open tibial fractures: a prospective, controlled, randomized study of four hundred and fifty patients","volume":"84","author":"Govender","year":"2002","journal-title":"J Bone Joint Surg Am."},{"issue":"7","key":"bib33-20260605","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.2106\/JBJS.E.00381","article-title":"Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects. A randomized, controlled trial","volume":"88","author":"Jones","year":"2006","journal-title":"J Bone Joint Surg Am."},{"issue":"8","key":"bib34-20260605","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1097\/BOT.0000000000001492","article-title":"A randomized controlled trial comparing rhBMP-2\/Absorbable collagen sponge versus autograft for the treatment of tibia fractures with critical size defects","volume":"33","year":"2019","journal-title":"J Orthop Trauma."}],"container-title":["JBJS Case Connector"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.26.00065","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:40:36Z","timestamp":1787751636000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.CC.26.00065"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":34,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.cc.26.00065","relation":{},"ISSN":["2160-3251"],"issn-type":[{"value":"2160-3251","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}