PMC5013249_01
Large soft tissue defect.
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The patient had about 15 cm of soft tissue loss along posterior side of the left lower leg and 8 cm of an exposed tibia fragment upon presentation (Fig. 1) and radiographic examination (Fig. 2a, b).
a: The autologous tibia bone graft. b: The bone in the abdominal wall.
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After the loose fracture fragment in the tibia diaphysis was placed between layers of the peritoneum (Fig. 3a, b), stabilization of the fracture was obtained using an AO type external fixator.
a and b postoperative anteroposterior and lateral radiographies of the crus.
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Two grams of bone cement were mixed with teicoplanin was placed in the defect area of the bone (Fig. 4a, b).
Anteroposterior and lateral radiographies of the crus 1 day after the operation.
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CRP and sedimentation levels decreased to normal levels, and the split thickness skin graft was considered successful on 50th day of follow-up. Consequently, after the vitality of the bone fragment, which had been maintained between layers of the peritoneum, was checked using 3-phase bone scintigraphy, intramedullary osteosynthesis was performed with the tibia fragment (Fig. 5).
a and b figures display the paprika sign.
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The paprika sign was observed on the autologous segmental tibia during the operation (Fig. 6).
Postoperative 7th month, osteolysis in the fracture area, full union in the area of the fibula fracture, and synostosis in the proximal side of the fracture line.
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Conversely, full union resulted in the area of the fibula fracture with synostosis in the proximal side of the fracture line (Fig. 7).