Tibialization of Fibula for Large Segment Tibia Loss Following Chronic Osteomyelitis

The tibia is the larger and stronger of the 2 bones in the lower leg, acting as the major weight-bearing and load-transferring bone between the knee and the ankle. Its subcutaneous location makes it particularly prone to trauma. When such injuries fail to heal, become infected, or remain exposed, large segmental bone loss can occur, creating significant reconstructive challenges to restore function. We present the case of a 10-year-old boy who sustained a trivial stick injury to his left leg that became infected, resulting in extensive tibial necrosis and exposure. Initial attempts at debridement, cortical drilling, a cross-leg flap, and split-thickness skin grafting at a peripheral hospital were unsuccessful. After referral to our center, thorough debridement of the sequestrum was performed, followed by wound care with Dakin solution for 3 weeks; cultures showed no growth. Reconstruction was achieved by tibializing the ipsilateral fibula with an overlying skin paddle. The fibula stabilized with a biplanar inverted delta frame external fixator, along with additional pins on the overlapping segments. The fixator was removed 6 months postoperatively after radiological confirmation of bony union. At 14 months, the patient can walk short distances unaided and uses crutches for longer distances. He remains in physical therapy for residual stiffness of the knee and ankle joints and to optimize functional recovery. Ipsilateral fibular tibialization remains a dependable limb-salvage option for large tibial defects in children, especially where microsurgical alternatives are limited.