Osteochondral allograft in the treatment of an extruded osteoarticular segment of the distal tibia: A case report

Abstract

Open tibial plafond fracture with massive bone loss presents a challenge for orthopedic surgeons. Particularly unusual is extrusion of an osteoarticular segment of the distal tibia. Here we present the case of such a patient, who was treated using osteochondral allograft (OCA) and fusion procedures. The patients can regain independent walking without pain within 6 months, indicating that OCA may be a sensible option for the treatment of open tibial plafond fracture with extrusion of the osteoarticular distal tibia in cases in which the surrounding soft tissue is intact but bone reimplantation is not possible due to severe damage and contamination.

Keywords: Ankle joint; Limb salvage; Massive bone loss; Osteochondral allograft; Tibial plafond fracture.

Fig. 1

(A) An inside-out open wound on the lateral aspect of the right heel was initially observed. (B) Initial radiograph of the right leg revealed massive bone loss of the distal tibia and fracture of the midshaft fibula.

Fig. 2

Postoperative radiographs after the first operation. A joint-bridging triangular external fixator was used and open reduction and internal fixation with a one-third tubular plate at the shaft fibula were performed.

Fig. 3

Postoperative radiographs after the second operation. A matched OCA was fixed with a distal tibial locking plate. Tibiotalar joint fusion with multiple screws was performed and an autogenous bone graft was placed around the docking site.

Fig. 4

At 6 months post-operation, the patient was ambulating independently without pain and was able to stand on one leg on the injured side. AOFAS score was 79.

Fig. 5

(A) Postoperative radiographs at 12 months revealed interval healing callus formation at the tibial and allograft docking site. (B) Postoperative radiographs at 24 months.

Fig. 6

Scanogram at 12 months revealed that the right leg was 2 cm shorter than the left.