Ipsilateral Momentary Fibular Transfer in an Large Tibia Defect Using Ring Fixator: A Case Report

Kim, Hak Sun; Chun, Churl Hong; Kim, Hye Jung

Abstract

Massive segmental bony defect in open tibial fractures are generally treated with conventional bone grafting, free vascularized fibular graft or ring fixator technique. There are corcumstance when conventional bone graft is not adequate. A vascularized fibular graft may be superior to conventional graft, but it is with ring fixator is alternative method. The procedure can be accomplished by transferring the osteotomized part of the fibula to the tibia by means of olive wires. There was a 20-year-old male patient with Gustilo type IIIc open tibial fracture. Soft tissue defect was severe and femoral angiogram was perfomed. Only tibialis posterior artery was patent and peroneal artery was partially damaged. Latissmus dorsi flap was performed for covering soft tissue defect. Since the only patent tibialis posterior artery was already used for latissmus dorsi flap, it was difficult to perform vascularized fibular graft. Also it was technically difficult for us to accomplish a gradual transport using ring fixator because the distal tibia was lost. Thus, the fibular transfer was performed immediately after the ring fixator was applied. Good bony union and fibular hypertophy were obtained even though these two procedure had been done simultaneously.