Reconstruction of Traumatic Open Extensor Loss With Achilles Calcaneus Allograft

We report a 35-year-old male truck driver presenting after a motor vehicle rollover sustaining a 20 x 10 cm open grade 3B proximal tibia fracture with traumatic extensor mechanism loss undergoing acute extensor reconstruction and soft tissue coverage. After serial debridement bridged by local and intravenous (IV) antibiotics, definitive reconstruction with Achilles calcaneus allograft and medial-lateral gastrocnemius flap coverage was performed within 10 days. The patient achieved an excellent clinical outcome with <5-degree extensor lag, 100-degree knee flexion, and full quad strength. We demonstrate successful reconstruction of the traumatic extensor mechanism within the acute injury period.