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Preoperative X-ray on the admission day demonstrating the bone defect.
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He had a right Gustilo IIIA segmental open tibial fracture with bone loss (Fig. 1), bilateral knee dislocation with right patellar tendon rupture, left anterior cruciate ligament (ACL) and medial cruciate ligament (MCL) rupture, bilateral distal femoral condyle fracture, grade II liver injury and grade III splenic injury.
Corticotomy was performed and Ilizarov apparatus was applied.
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Corticotomy was performed to the distal segment to transport it proximally (Fig. 2).
Fine lines of regenerate formation.
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The appearance of the regenerate on X-ray began 20 days after starting the distraction (Fig. 3).
X-ray demonstrating the regeneration after completing the distraction period.
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The distraction was continuous and lasted for seven months until the tibia restored its original length (Fig. 4).
Ilizarov frame removal after proper consolidation with partial union at docking site.
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Two years later, the Ilizarov frame was removed after confirming good bone healing with X-ray (Fig. 5).
X-ray demonstrates internal fixation and MIPO of docking site.
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Open reduction internal fixation (ORIF) of mid-tibia and bone graft for the docking site was performed using Minimal Invasive Percutaneous Osteosynthesis (MIPO) (Fig. 6).
Docking site compression with two rings to manage the nonunion.
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IV antibiotics, and three months course of oral antibiotics upon Infectious Disease team consultation. Ilizarov frame was re-applied to the proximal segment with two rings to compress the malunion of docking site (Fig 7).
The final x-ray with full weight-bearing.
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However, as the patient suffered from an interaction of multiple complex injuries that are not limited to the tibia, the functional outcomes of the final repair were difficult to assess (Fig. 8).