Talofibular Fusion and Lengthening to Reconstruct a Failed Distal Tibia Allograft Defect After Osteosarcoma Resection

This is a 20-year-old male who presented with progressive right ankle deformity and leg length discrepancy after distal tibia osteosarcoma resection with allograft reconstruction performed at the age of 11. Radiographs demonstrated allograft failure with resorption and fracture. His fibula was hypertrophic. He was treated with talus transfer and fusion to the distal fibula with a hexapod frame restoring length and alignment without requiring formal bone transport. After hexapod reconstruction, he was converted to internal implants. At final follow-up, he is healed, pain free, and ambulating without assistive devices.