Acute emergency tibialization of the fibula: reconstruction of a massive tibial defect in a type IIIC open fracture

Fatih Parmaksızoğlu,A Yener Ince,Mehmet Bekir Ünal,Eren Cansü

doi:10.1007/s11751-013-0167-6

Abstract

Gustilo type IIIC open fractures of the tibia are high-energy injuries necessitating long treatment periods and usually multiple surgical procedures and eventually resulting in high morbidity rates and even amputations. We present here a case involving a type IIIC open tibial fracture with massive loss of the entire tibial diaphysis, which we treated by performing acute tibialization of the fibula after revascularization of the posterior tibial artery in a single-stage emergency operation.

Highlights

IntroductionA number of techniques have been described for salvage of the injured limb, including serial massive debridement and early flap closure, autologous bone grafting, vascularized or non-vascularized transfer of the ipsilateral or contralateral fibula, segmental transposition, tibiofibular synostosis, and acute shortening and relengthening
A number of techniques have been described for salvage of the injured limb, including serial massive debridement and early flap closure, autologous bone grafting, vascularized or non-vascularized transfer of the ipsilateral or contralateral fibula, segmental transposition, tibiofibular synostosis, and acute shortening and relengthening.We report a case of a Gustilo type IIIC open fracture with massive loss of the tibial diaphysis
We present here a case involving a type IIIC open tibial fracture with massive loss of the entire tibial diaphysis, which we treated by performing acute tibialization of the fibula after revascularization of the posterior tibial artery in a single-stage emergency operation

Summary

Introduction

A number of techniques have been described for salvage of the injured limb, including serial massive debridement and early flap closure, autologous bone grafting, vascularized or non-vascularized transfer of the ipsilateral or contralateral fibula, segmental transposition, tibiofibular synostosis, and acute shortening and relengthening. Tibialis posterior artery was repaired at the level of the ankle during emergency surgery, and immediate intramedullary insertion of the ipsilateral fibula on its peroneal arterial pedicle between the two preserved edges of the tibia was performed in a single procedure To our knowledge, this is the first case in which emergency singlestage acute tibialization of the fibula is described. The other injuries were treated as follows: proximal femoral nailing for the intertrochanteric fracture; intramedullary nailing for the left tibial fracture; and placement of a propeller flap for the calcaneal skin defect. These were performed at 2 weeks once it was declared the right side. An insole was prescribed, it was not used by the patient for most of the day

Discussion

Conclusion