Occult Femoral Arteriovenous Fistula and Pseudoaneurysm after a Gunshot-Associated Subtrochanteric Fracture: Transfusion-Refractory Anemia as the Sentinel Sign - A Case Report.

INTRODUCTION: Infected tibial shaft non-union after internal fixation is a difficult orthopedic problem because infection control, fracture stability, and bone healing must be achieved simultaneously. Ilizarov external fixation is a valuable limb salvage option in such complex cases. This case is important because a successful union was achieved despite persistent infection, skin necrosis, and the need for subsequent skin grafting.

CASE REPORT: A 26-year-old Bangladeshi male presented with an infected non-union of the left tibial shaft after plate fixation performed at a private clinic. Postoperatively, infection developed with wound breakdown and exposed implant. The plate was removed under spinal anesthesia. One month later, Ilizarov external fixation with autogenous iliac crest bone grafting was performed. After surgery, the patient developed severe infection with skin necrosis, which was managed with regular dressing and later skin grafting. Although infection persisted for several months, the Ilizarov frame was maintained. The infection gradually settled, and the frame was removed after 9 months. Final radiographs demonstrated satisfactory union.

CONCLUSION: This case demonstrates that Ilizarov external fixation can successfully salvage infected tibial shaft non-union after implant removal, even when prolonged infection and soft-tissue complications occur. The clinical impact of this report lies in showing that stable circular fixation, combined with persistent wound care and staged management, can achieve infection control and union in a difficult limb salvage situation.