Immediate ipsilateral fibular transfer in a large tibial defect using a ring fixator. A case report

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Bone Reconstruction

Background:

• Massive segmental bony defects in open tibial fractures present significant reconstruction challenges.
• Conventional bone grafting and free vascularised fibular grafts have limitations, including technical difficulty and occasional impossibility.
• The ring fixator technique is an alternative, but gradual transport can be difficult with significant distal bone loss.

Observation:

• A 20-year-old male with a Gustilo type IIIB open tibial fracture had a severe soft tissue defect and compromised arterial supply.
• A latissimus dorsi flap was used for soft tissue coverage, precluding the use of the patent tibialis posterior artery for a vascularised fibular graft.
• Distal tibia loss made gradual transport with a ring fixator technically challenging.

Findings:

• A simultaneous fibular transfer and ring fixator application was performed.
• The osteotomised fibula was transferred to the tibia using olive wires.
• The procedure resulted in good bony union and significant fibular hypertrophy.

Implications:

• Fibular transfer in conjunction with a ring fixator is a valuable alternative for complex tibial defects where vascularised fibular grafts are not possible.
• This combined technique can achieve successful bone healing and graft hypertrophy even in challenging trauma scenarios.
• It expands the reconstructive options for severe open tibial fractures with extensive bone and soft tissue loss.