Delayed Diagnosis of an Ipsilateral Patellar Fracture in an Open Segmental Tibial Fracture Managed With Ilizarov External Fixation: A Case Report.

Open segmental tibial fractures are challenging injuries because of their high-energy mechanism, associated soft tissue compromise, and increased risk of infection and delayed union. Ilizarov circular external fixation provides stable fixation while preserving fracture biology and allowing early rehabilitation. This report describes the case of a 45-year-old male who sustained a Gustilo-Anderson type I open segmental comminuted fracture of the right tibia with an associated ipsilateral mid-shaft fibula fracture. Definitive management was performed with wound debridement and Ilizarov circular external fixation. During follow-up, an ipsilateral patellar fracture that had not been identified at initial presentation was diagnosed radiographically and subsequently treated with modified tension band wiring. Follow-up radiographs demonstrated maintained alignment, progressive callus formation, and progression toward union, while postoperative patella radiographs showed satisfactory fixation. This case highlights the effectiveness of Ilizarov circular external fixation in the management of open segmental tibial fractures and emphasizes the importance of careful evaluation of adjacent joints to avoid delayed diagnosis of associated injuries.