Tibio-fibular synostosis - a viable option in the management of segmental tibial loss: case report

Abstract

Segmental tibia loss resulting in gap non-union presents a major challenge to the orthopaedic surgeon, especially when associated with infection, old or active osteomyelitis, and multiple previous surgeries. This is made rather worse in the presence of extensive skin and soft tissue scarring. Several options of treatment have been proposed with the most recent advance being the Ilizarov technique. However, in the face of extensive skin and soft tissue scarring especially in the anterior and antero-medial portions of the leg, bone transport becomes almost impossible and resort to other methods of treatment become handy.

We report a case of segmental tibial loss in a26-year-old man who presented to the outpatient clinic with a two-year history of gap non-union of the right tibia (8cm) following a road traffic accident. This was complicated by a chronic ulcer seating on scar tissue with extensive skin and soft tissue scarification and muscle atrophy. He was successfully managed by proximal tibio-fibular synostosis with radiological evidence of distal tibio-fibular synostosis. Limb length and alignment were fully restored.

Keywords: Antibiotics, bone graft, gap non-union, Kirschner wire, segmental