Soft-Tissue Closure through Acute Deformation and Gradual Correction Using Taylor Spatial Frame in a Gustilo-Anderson Type IIIB Open Tibial Pilon Fracture: A Case Report.

INTRODUCTION: Purpose: Gustilo-Anderson Type IIIB open tibial fractures resulting from high-energy trauma present significant challenges for both skeletal stabilization and soft-tissue reconstruction. We present a case of successful management using acute deformation and gradual correction with the Taylor Spatial Frame (TSF), without the need for free tissue transfer, and discuss the clinical value of this approach in the context of contemporary literature.

CASE REPORT: A 32-year-old male with a gunshot-related distal tibial Type IIIB open fracture presented with a failed skin graft and a persistent soft-tissue defect. A 110° acute varus deformity was created with TSF to allow tension-free primary wound closure. Deformity correction was performed gradually using computer-assisted TSF software. The resulting limb shortening was addressed with proximal tibial corticotomy and distraction osteogenesis. At 7 months, infection-free healing and functional limb recovery were achieved.

CONCLUSION: In selected open fractures with soft-tissue loss, controlled acute deformity at the fracture site allows primary wound closure, after which anatomical alignment can be gradually restored with TSF. Current systematic reviews and multicenter studies support the artificial deformity creating technique as a means of reducing the need for microsurgery and enabling safe limb salvage when appropriate patient selection is applied.