Adolescent with Segmental Bone Defect Secondary to Grade IIIB Open Tibial Fracture Treated by Oblique Wire Bone Transport

Thirteen-year-old male sustained multiple fractures in a rollover bus accident including Gustilo-Anderson grade IIIB open right tibial fracture as well as severe traumatic brain injury necessitating a prolonged ICU stay. Initial treatment consisted of repeated irrigation and debridement, followed by insertion of flexible stainless steel Ender’s nails. Ten days postoperatively, infection necessitated aggressive bony debridement which resulted in a 10-cm bone defect and placement of a temporary spanning frame. Later, pin-to-bar external fixator was converted to TrueLok circular external fixator followed by proximal tibial osteotomy and 10-cm oblique wire bone transport.