Extra-Articular Distal Tibia Non-Union Treated With Ipsilateral Fibular Strut Graft with Implants In Situ - A Case Report.

INTRODUCTION: Distal tibial comminuted fractures are usually a result of high-energy trauma. The subcutaneous location of the bone pre-disposes to open fractures and decreased vascular supply. All these local and biological factors contribute to increased risk of non-union. Mechanical factors such as stability of the fixation and method of fixation also add to it. Hence, it is prudent to evaluate all these factors in a case of distal tibial non-union and choose optimal method of management of distal tibia non-union. This case presentation is portrayal of one such scenario.

CASE REPORT: A 65-year-old male patient presented with non-union of extra-articular distal tibia comminuted fracture with distal tibial locking compression plate and fibular plate in situ. He was treated with ipsilateral fibular bone grafting and retention of the implants about 1 and 1/2 years after the injury. The bone has united within 11 months with uneventful post-operative period and with good functional outcome.

CONCLUSION: This case shows that even with minimal intervention union can be achieved in notorious distal tibia non-unions if appropriate graft materials are chosen and customized accordingly. Evaluating various biological and mechanical causes of non-union and addressing them is key to favorable outcomes.