Distal Tibia-Ankle Reconstruction with Bone Transport Fusion After Resection of Osteosarcoma

A 16-year-old female underwent resection of a low grade left distal tibia osteosarcoma leaving a ~6 cm distal tibia bone defect. She was treated with bone transport and simultaneous proximal tibial lengthening to create a tibiotalar fusion using a two-level hexapod external fixator. This technique achieved equal leg lengths and a stable ankle at the end of treatment while avoiding amputation. At the last follow up, she began to develop subtalar joint arthritis, managed with a lateral heel wedge, and mild rocker bottom shoe orthosis for symptomatic relief. She is otherwise ambulating well unassisted.