PMC9957684_01
Evaluation visit photograph showing a left tibia with varus malalignment.
cureus-0015-00000034212-i01.jpg
PMC9957684_01_cureus-0015-00000034212-i01.jpg
FIG1
A 25-year-old female presented to our orthopaedic trauma service for evaluation of an infected left tibial shaft non-union with a 5 cm bone defect, 6 cm limb length discrepancy, and varus malalignment (Figures 1, 2).
(A) Anteroposterior and (B) lateral radiographs of a left tibia non-union demonstrating a significant bony defect with varus malalignment and diffuse osteopenia.
cureus-0015-00000034212-i02.jpg
PMC9957684_01_cureus-0015-00000034212-i02.jpg
FIG2
A 25-year-old female presented to our orthopaedic trauma service for evaluation of an infected left tibial shaft non-union with a 5 cm bone defect, 6 cm limb length discrepancy, and varus malalignment (Figures 1, 2).
CT angiography revealing occlusion of left anterior tibial artery near the level of defect.
cureus-0015-00000034212-i03.jpg
PMC9957684_01_cureus-0015-00000034212-i03.jpg
FIG3
CT angiography demonstrated complete occlusion of both her anterior and posterior tibial arteries (Figures 3, 4) at the level of the fracture and MRI revealed persistent tibial osteomyelitis. 
CT angiography revealing occlusion of left posterior tibial artery near the level of defect.
cureus-0015-00000034212-i04.jpg
PMC9957684_01_cureus-0015-00000034212-i04.jpg
FIG4
CT angiography demonstrated complete occlusion of both her anterior and posterior tibial arteries (Figures 3, 4) at the level of the fracture and MRI revealed persistent tibial osteomyelitis. 
Postoperative photographs of the patient's leg after placement of a cement spacer and external fixator.
cureus-0015-00000034212-i05.jpg
PMC9957684_01_cureus-0015-00000034212-i05.jpg
FIG5
She then underwent irrigation and debridement of the left tibia, placement of an antibiotic cement spacer, rectus abdominus free flap, and static external fixation (Figures 5, 6), with a plan to return to initiate bone transport after flap maturation.
Postoperative (A) anteroposterior and (B) lateral radiographs of the left tibia after placement of a cement spacer and external fixator.
cureus-0015-00000034212-i06.jpg
PMC9957684_01_cureus-0015-00000034212-i06.jpg
FIG6
She then underwent irrigation and debridement of the left tibia, placement of an antibiotic cement spacer, rectus abdominus free flap, and static external fixation (Figures 5, 6), with a plan to return to initiate bone transport after flap maturation.
Intra-operative fluoroscopic images demonstrating (A) anteroposterior and (B) lateral positioning of trial implants confirming adequate bony contact and alignment.
cureus-0015-00000034212-i07.jpg
PMC9957684_01_cureus-0015-00000034212-i07.jpg
FIG7
Using the blocking screw technique both proximal and distal to the segmental defect, an intramedullary nail was inserted and passed through the 3D-printed titanium mesh cage and statically locked (Figures 7, 8, 9).
(A) Anteroposterior and (B) lateral views showing reaming of the tibial shaft through the trial implant.
cureus-0015-00000034212-i08.jpg
PMC9957684_01_cureus-0015-00000034212-i08.jpg
FIG8
Using the blocking screw technique both proximal and distal to the segmental defect, an intramedullary nail was inserted and passed through the 3D-printed titanium mesh cage and statically locked (Figures 7, 8, 9).
(A) Proximal segment posterior blocking screw and (B) distal segment medial blocking screw ensuring optimal placement of intramedullary tibial nail.
cureus-0015-00000034212-i09.jpg
PMC9957684_01_cureus-0015-00000034212-i09.jpg
FIG9
Using the blocking screw technique both proximal and distal to the segmental defect, an intramedullary nail was inserted and passed through the 3D-printed titanium mesh cage and statically locked (Figures 7, 8, 9).
The patient was able to ambulate independently at the one-year follow-up.
cureus-0015-00000034212-i10.jpg
PMC9957684_01_cureus-0015-00000034212-i10.jpg
FIG10
At the one-year follow-up, the patient reported no pain and remained independent in ambulation using a custom ankle foot orthosis with lift for stabilization (Figure 10).
One-year postoperative (A) anteroposterior and (B) lateral radiographs of the left tibia demonstrating 3D-printed titanium implant and intramedullary nail with restored alignment and segmental bony defect.. 3D: three-dimensional
cureus-0015-00000034212-i11.jpg
PMC9957684_01_cureus-0015-00000034212-i11.jpg
FIG11
X-rays demonstrated intact hardware at both ends of the 3D implant (Figure 11).