Infected Nonunion of the Tibia

Tibial shaft fractures are often challenging to treat. Our patient presented with an established tibial shaft nonunion, complicated by long-standing, likely polymicrobial, infection. In addition, the patient’s biomechanics were altered due to a prior ipsilateral pantalar fusion. The patient is a 54 year old female who presented to our clinic with a tibial shaft nonunion 13 months after ankle arthrodesis. The patient sustained an open ankle fracture 23 years before, resulting in post-traumatic arthritis and persistent pain. Since the successful arthrodesis, she had a tibial shaft fracture and several fixation attempts. She had been given oral antibiotics for an E. coli infection for 9 of 13 months. At our institution, debridement of the infection was done in stages until adequate, and depot antibiotics were placed directly in the tibial canal to treat the infection at its deepest site. She ultimately underwent Ilizarov frame fixation, resulting in successful healing of the fracture. Her treatment also included IV antibiotics, antibiotic cement, and autologous bone graft. The enhanced stability of our construct allowed full weight bearing, aided pain control, and facilitated the patient’s participation in activities of daily living and even professional and recreational activities.