Abstract
Introduction and Aims: I was presented with a Land-mine victim with closed fracture of right talus, compound injury to left lower limb, and defect in heelpad. Distal third of tibia and most of hindfoot were missing. Left foot neurovascularly intact and he was able to move his toes. Aim: reconstruct left distal tibia to enable full weight-bearing.
Method: Lower leg debrided. LRS applied, using proximal ring with Sheffield clamp and two rings around foot. Corticotomy of proximal tibia. Bone transport, 10 days later. Heel debridement, to clear necrotic bone. Two months later transported bone was 2cm from ankle. Sepsis controlled. Distal tibia beveled, bone transport continued.
Docking procedure performed. Ex-fix adjusted, attaining compression of hindfoot and midfoot. Distal tibia and foot transported 4cm, to correct disproportion. Osteoset used for bone growth. During the following two years, length discrepancy resolved, sepsis manageable. X-rays showed two cortices between proximal tibia and transported tibia. Fixator removed two months later. Received orthotic boot.
Results: In September 2003 the patient came for follow-up. There was no evidence of sepsis in the leg. He was full weight-bearing using an orthotic shoe and rocker bottom sole. There was no pain. He had left the army and was now working as a builder in his country of origin and putting in a whole day’s work. The length of the transported segment is approximately 14cm. It is now fully consolidated and four cortices are visible on x-ray. The fusion of the distal tibia into the foot is solid and no pain is experienced from that.
Conclusion: Big defects in the distal tibia can be managed with a straight rail reconstruction system, using unifocal bone transport with proximal corticotomy.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
