The "Bell-Tent Technique" for Management of Periarticular, Cavitary Bone Defects of the Tibia: A Case Report

Cavitary bone defects require complex, multidisciplinary reconstructive modalities, ranging from bone regeneration using distraction osteogenesis to the induced membrane technique and its modifications. The aim of this study was to put forth an innovative way of managing large, peri-articular cavitary defects, using a modified Masquelet technique along with the addition of a surgical polypropylene mesh.

A 34-year-old male, with a large, peri-articular cavitary bone defect of the proximal tibia, underwent joint preservation surgery using the combination of a non-vascularized fibula along with cancellous autografting, secured using a polypropylene mesh. The design of this construct resembled a camping tent, which is why it was given that name. A knee-spanning Ilizarov frame provided the requisite stability until clinico-radiological union.

Clinico-radiological union was achieved at 9 months following the frame application. At final follow-up of 37 months, he demonstrated a clinically stable knee with 0-70° of flexion (5° extensor lag persisted), which enabled him to use stairs and public transport, and radiographs showed a consolidated proximal tibia in good alignment. The patients' adjacent joints were salvaged, and the bone defect healed without any major complications. His skin defect required a supplementary medial gastrocnemius flap.

The bell-tent technique may represent a useful joint-preserving reconstructive option for selected patients with large peri-articular cavitary defects of the tibia. In this case, it facilitated biological reconstruction, maintenance of limb alignment, and preservation of adjacent joint function. Further studies are required to establish its reproducibility and long-term outcomes.