Fibular tibialization for reconstruction of segmental tibial defects

Abstract

Introduction: Fibular tibialization, initially proposed by Hahn and later refined by Huntington, is a reconstructive technique used to manage extensive tibial segmental defects. It represents a biological autologous alternative, particularly valuable when conventional methods such as isolated bone transport or large grafting are not feasible. Gustilo-Anderson IIIC open tibial fractures remain among the most challenging orthopedic injuries, often requiring complex multidisciplinary limb salvage strategies. Objective: To report and analyze the first case of fibular tibialization performed at the Hospital Estadual de Anápolis Dr. Henrique Santillo (HEANA), emphasizing its applicability for limb salvage following high-energy trauma with extensive bone loss. Case Report: A patient involved in a motorcycle accident sustained a severe Gustilo-Anderson IIIC open fracture of the left tibia, associated with vascular injury and a 12 cm segmental bone defect. Initial management included temporary external fixation, fasciotomy, revascularization, and serial debridements. After adequate soft tissue coverage, fibular osteotomy and gradual medial transport were performed using an Ilizarov circular external fixator. The course required multiple surgical revisions, complementary tibial bone transport, autologous tricortical iliac crest grafting, and progressive consolidation. Late sequela included rigid equinus deformity, treated with ankle arthrodesis. Conclusion: Fibular tibialization combined with the Ilizarov technique is an effective limb salvage option for severe open tibial fractures with extensive segmental bone loss. This case highlights the importance of staged multidisciplinary management and demonstrates the feasibility of advanced reconstructive approaches in the Brazilian hospital setting.