CASE REPORT article
Front. Vet. Sci.
Sec. Veterinary Surgery
Case Report: Calcium Sulfate Antibiotic Beads and Bone Morphogenetic Protein-2–Loaded Hydroxyapatite and Allograft for the Treatment of Infected Delayed union in a Dog
Provisionally accepted
- 1College of Veterinary Medicine, Kangwon National University, Chuncheon, Republic of Korea
- 2Seoul National University College of Veterinary Medicine, Seoul, Republic of Korea
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A 6-year-old male German Shepherd dog was presented with a closed, highly comminuted fracture of the left tibia caused by a fall. The fracture was stabilized using a plate-and-rod construct that was further protected with an external skeletal fixator. However, the surgery resulted in an external torsional deformity of the left tibia. Therefore, 23 weeks after the first surgery, an additional deformity-correction surgery was performed based on the tibial torsion angle measured from computed tomography scans. At 28 weeks after the first surgery, osteomyelitis at the osteotomy site in the left tibia, caused by methicillin-resistant Staphylococcus aureus, was diagnosed based on culture and antimicrobial susceptibility testing, and this infection was considered to hinder bone healing. At 28 weeks after the first surgery, a third surgery was performed in which calcium sulfate antibiotic beads and antibiotic-impregnated collagen sponges, together with hydroxyapatite and allografts loaded with recombinant human bone morphogenetic protein-2, were grafted for treatment of osteomyelitis and to promote bone healing. Six weeks following the application of antibiotic beads and bone graft materials, clinical bone union was observed. Complete bone healing was confirmed using radiographic imaging, and functional recovery was verified using objective gait analysis. The implant was subsequently removed to prevent stress shielding and the associated peri-implant bone loss. In conclusion, a tissue engineering strategy combining local antibiotic delivery using calcium sulfate antibiotic beads with bone graft substitutes loaded with recombinant human bone morphogenetic protein-2 can overcome the limitations of systemic antibiotic therapy and may be a viable option for treating infected tibial delayed union.
Keywords: Bone morphogenetic protein-2, bone tissue engineering, Calcium sulfate antibiotic beads, case report, Delayed union, objective gait analysis, Osteomyelitis, Regenerative Medicine
Received: 22 Sep 2025; Accepted: 10 Feb 2026.
Copyright: © 2026 Cho, Kang and Kim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: JUNHYUNG Kim
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