Immediate ipsilateral fibular transfer in a large tibial defect using a ring fixator

Abstract

Massive segmental bony defects in open tibial fractures are generally treated with conventional bone grafting, a free vascularised fibular graft or the ring fixator technique. A vascularised fibular graft may be superior to a conventional bone graft, but it is technically difficult and occasionally impossible. In such circumstances, fibular transfer in conjunction with a ring fixator is an alternative method. This procedure can be accomplished by transferring the osteotomised part of the fibula to the tibia by means of olive wires. The authors have treated a 20-year-old male who presented with a Gustilo type IIIB open tibial fracture. The soft tissue defect was severe, only the tibialis posterior artery was patent and the peroneal artery was partially damaged. A latissimus dorsi flap was performed to cover the soft tissue defect. Since the patent tibialis posterior artery had already been used for the flap, it was difficult to perform a vascularised fibular graft. Moreover, it was technically difficult to accomplish a gradual transport using a ring fixator because the distal tibia was lost. For this reason, the fibular transfer was performed immediately after the ring fixator was applied. Good bony union and fibular hypertrophy were obtained even though these two procedures were undertaken simultaneously.