Tibialization of Fibula in an Implant Failure Non-Union Poliotic Limb: A Case Report

Non-union of long bone fractures, particularly of the tibia, presents considerable challenges due to poor vascularity, minimal soft-tissue coverage, and complications such as implant failure or infection from previous surgeries. Tibialization of the fibula remains a viable, though underreported, technique for addressing such complex cases.

We report a case of a 26-year-old male with a history of poliomyelitis who presented with non-union of the left tibia following implant failure. Clinical evaluation revealed 4 cm limb shortening and varus deformity. Radiographs showed a broken 4.5 mm limited contact dynamic compression plate and multiple loosened screws. Given the intact fibula and adequate vascular and soft-tissue status, the Huntington method for tibialization was selected. The surgical approach included implant removal, debridement of non-union margins, and medial transfer of the fibula using anterolateral and lateral approaches. Postoperatively, the patient experienced transient vascular compromise, which resolved without intervention. At 6 months, radiographs confirmed proximal tibiofibular union, and the patient had regained functional mobility.

Fibular tibialization using the Huntington procedure offers a low-complexity, implant-sparing solution for managing tibial non-union, especially in patients with compromised bone and soft-tissue conditions. This case demonstrates favorable outcomes with minimal complications.