Failed Proximal Tibia Allograft: Limb Salvage with Trifocal Tandem Transport

An 18-year-old female was referred to our office with right tibia pain, deformity, and shortening. She had a history of right tibia osteosarcoma diagnosed at the age of 11. Her allograft reconstruction was complicated by proximal junction nonunion, allograft fracture, and hardware failure. Critically, she had a well-preserved knee articular surface and no quadriceps extensor lag on exam. In order to preserve her knee joint, she was treated with allograft excision and trifocal bone transport with a 4-ring external fixator. At final follow up, she was able to return to all activities without pain, has minimal leg length discrepancy for which she prefers no lift, and has full knee range of motion.