Extra-Articular Tibial Shaft Ilizarov Failed Fixation

Fine wire circular frames are frequently used to manage complex tibial fractures. Though reported clinical outcomes are good, the nature of the injuries treated means that there remains a risk of delayed and non-union. When this occurs, it is important to evaluate the patient carefully for causes of non-union before undertaking revision surgery. We present a case of a patient with an apparently simple fracture who failed initial non-operative management and subsequent Ilizarov treatment resulting in a recalcitrant non-union. On further investigation it transpired that the patient had undiagnosed Neurofibromatosis type-I with a late presentation of tibial pseudoarthrosis. The patient underwent successful management by excision of the non-union and internal fixation combined with a variety of bone healing adjuncts and a microvascular free periosteal transfer.