Tibial bone loss

Abstract

Critical bone loss after open fractures, while relatively uncommon, occurs most frequently in high-energy injuries. Fractures of the tibia account for the majority of open fractures with significant bone loss. A number of different surgical strategies exist for treatment of tibial bone loss, all with different advantages and disadvantages. Care should be taken by the surgeon to review appropriate indications and all relevant evidence before selecting a strategy.

Keywords: bone loss; defect; masquelet; reconstruction; tibia.

Figure 1.

Radiographs of a patient with traumatic distal tibial and fibular bone loss. Panel (A) shows the initial type IIIb open injury. After extensive debridement, PMMA cement was placed around an intramedullary Steinman pin with external fixation as part of an induced membrane technique (B, C). After 5 weeks, the patient was transitioned to definitive fixation of the tibial shaft fracture with intramedullary nailing along with extension of the construct into a tibio–talo–calcaneal fusion with supplemental fusion with a laterally based plate (D, E). The critical bone defect was successfully bridged by bone formation from the induced membrane.