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

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.

Fig. 1

a, b Massive injury to the tibia and the surrounding soft tissue

Fig. 2

Although nearly the entire tibial diaphysis had been destroyed, the fibula remained intact along its total length, except at its distal pole

Fig. 3

Preoperative radiograph of the fractured left femur

Fig. 4

Preoperative radiograph of the fractured left tibia

Fig. 5

An early postoperative radiograph shows that the fibula is seated well between the two poles of the tibia

Fig. 6

a, b Radiographs obtained 2 years after surgery show that the transferred fibula has been fully consolidated to allow full weight bearing. Thickening is well demonstrated