Tibiotalar arthrodesis as treatment for septic distal tibia osteomyelitis using bone transport with a monoplanar external fixator and flap coverage. A case report

Abstract

This article describes a complex case where an open tibial pilon fracture in a 39-year-old male resulted in septic pseudoarthrosis with articular involvement and skin necrosis. The infection was managed through a debridement with extended margins and an obliteration of the defect with an antibiotic-impregnated spacer. Once the infection was treated, the bone defect was filled by a bone transport procedure combined with a tibiotalar arthrodesis. The soft tissues were covered by means of a propeller flap. Although the final result of the case was satisfactory several lessons were learned, among them the need to always suspect an infection when treating open fractures in the distal tibia, the fact that a wide resection with application of local antibiotics contributes to successful management of osteomyelitis, and the usefulness of combining bone transport with flaps as a limb reconstruction procedure.