Free fibula transfer in the treatment of difficult distal tibia fractures

Management of the high-grade open distal tibia fracture remains problematic. The authors reviewed the charts of 14 cases of distal tibia and tibial plafond fractures reconstructed with a free fibula transfer. Six cases involved a plafond defect, and the fibula was used to arthrodese the tibio-talar joint. Seven cases included a skin paddle. Three of the four patients with osteomyelitis cleared their infection. Twelve patients went on to osseous union, and two were ultimately treated with amputation. Patients who went on to union had an average of 1.1 subsequent procedures, began full weightbearing in an average of 5.8 months, and were weightbearing without any assistive devices by an average of 8.5 months. There was no significant correlation between the time to full weightbearing and either the presence of infection or the length of the original defect. In this series, 86 percent success was obtained when a free fibula transfer was used either to bridge a tibial non-union or to promote arthrodesis of the tiblo-talar joint.