PMC4719225_01
20 year old female presenting with compound fracture of tibia treated with debridement and external fixator.
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F1
Fracture was fixed using a biplanar external fixator (Fig. 1).
three and half months post injury radiographs showing segmental tibia fragment with good union response at the proximal end; however the distal end appeared to be rounded with non bridging callus.
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F2
Radiographs showed that the segmental tibia fragment was showing good union response at the proximal end; however the distal end appeared to be rounded with attempt to callus formation which is non bridging (Fig. 2).
Radiograph showing bridge fibula graft done with stabilization using two screws and iliac crest cancellous bone graft between the tibia and fibula. Intact fibula can be appreciated to add a strut support to the tibia
JOCR-3-11-g003.jpg
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F3
This was done to make a rigid strut with cancellous graft in the middle (Fig. 3).
Clinical photographs five years post bridge grafting showing good ankle range.
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F4
Ankle dorsiflexion was restricted to 10  but the plantar flexion was around 50  (Fig. 4).
Five year follow up radiographs of the tibia showing good fracture unon with good alignment
JOCR-3-11-g005.jpg
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F5
The radiograph showed the fracture outline to have a silhouetted appearance with good union on posterior and medial side with good consolidation of the entire area of the bridge graft between tibia and fibula (Fig. 5).