Tibio-Fibular Fusion by Posterolateral Approach to Treat Nonunion of Tibia

A 30- year- old male has sustained open fracture of left leg and undergone 4 surgeries for four years (1. debridement and external fixator, 2. removal of external fixator, 3. vascularized contrafibular autograft plus change new plate/screws of ipsifibula, 4. flap surgery to cover the wound). At the time of examination: unability to walk, abnormal movements of leg, tibial bone loss 8 cm, especially the soft tissue of almost total anterior leg was so bad: no more subcutaneous tissue, skin very next to bone decouraging any attempt anterior approach. Diagnosis: pseudarthrosis of left leg with tibial large bone loss in the status of seriously damaged soft tissue of anterior leg surface. Technique operation chosen: Posterolateral. Appoach, Tibiofibular Fusion with massive autocancellous bone graft harvested from posterior iliac pelvis. Casting 4 months (from midthigh to metatarsal head). Postoperative walking with two crutches, Full Weight Bearing allowed after 14 weeks. Removal of cast after 16 weeks. Full knee flexion obtained 8 weeks after cast removal. Review at tenth month: normal walk, slight running, complete knee Range of Motion, 5. degree loss of dorsiflexion of ankle. X-rays: good fusion proximal and distal tibiofibular spaces and partly fusion the tibio-tibial gap. By this case,we can resumably conclude Tibiofibular Fusion through Posterolateral Approach should be strongly indicated for the leg nonunion in which the soft tissue of anterior surface is not favorable for nearby approach.