Abstract
The need for an ideal approach for the nonunion of the tibial shaft with anteromedial soft tissue scarring has long baffled surgeons. Many different approaches have been suggested in the past, but all those approaches were haggled by a multitude of problems. We have described a novel 'transfibular approach' for this selective situation. An appropriate patient with a mid-shaft tibial non-union was selected. After preoperative workup, the patient underwent an open reduction internal fixation (ORIF) with lateral tibial plating, bone grafting, and partial fibulectomy. In this new approach, the plane between tibialis anterior and extensor hallucis longus was used combined with a conventional posterolateral approach using the same incision. Subsequently, the patient was followed up for adequacy of the fixation and wound-related problems with a convincing outcome.
Highlights
The nonunion of a tibia with scarring over the anteromedial aspect of the leg is a challenging situation to manage through the standard approach [1]
We describe a novel unified lateral approach for such cases with a nonunited fracture of the tibial shaft and compromised anteromedial skin of the leg
The management of these cases includes partial fibulectomy and open reduction internal fixation (ORIF) with bone grafting for the nonunion tibia by avoiding compromised medial soft tissue
Summary
The nonunion of a tibia with scarring over the anteromedial aspect of the leg is a challenging situation to manage through the standard approach [1]. No unified approach has been described which enables lateral tibial plating, bone grafting, and partial fibulectomy through the same incision. We describe a novel unified lateral (transfibular) approach for such cases with a nonunited fracture of the tibial shaft and compromised anteromedial skin of the leg. How to cite this article Vaishya R, Agarwal A, Singh H, et al (September 03, 2015) A Novel 'Transfibular Approach' for the Nonunion of a Tibial Shaft Fracture with Poor Anteromedial Soft Tissue Cover. At the end of six months, there was hypertrophic varus non-union at the tibial site that was apparent on the preoperative x-rays (Figure 2). An open reduction and internal fixation (ORIF) of the tibia, bone grafting, and partial fibulectomy were planned, but due to a compromised anteromedial soft tissue cover, the standard approach could not be used. Postoperative follow-up x-ray of the leg was satisfactory (Figure 6)
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