Tibial Nonunion with Angular Deformity Treated with Taylor Spatial Frame to Gradually Correct and Lengthen

Tibial nonunionTaylor spatial frameForty-eight-year-old man who is a smoker had a closed segmental tibial and fibular fracture (left leg) after a motor vehicle accident. An intramedullary nail was inserted but became infected. The nail was removed, and the leg was placed in a cast. When an ulcer developed, the cast was removed. Then the patient underwent treatment with bone graft and external fixation with subsequent frame removal. Two years after treatment, he presented to our center with pain and distal tibial varus and procurvatum. The site of the distal fracture was mobile, but the ankle and subtalar joints were stiff. His right limb had a 4-cm limb length discrepancy. No evidence of active infection was observed. The leg was evaluated with computed tomography (CT), which was used to rule out nonunion at the proximal tibial fracture site. A Taylor Spatial Frame was applied to correct the deformity and restore length through this hypertrophic nonunion. Distraction began 1 week after surgery, and weight-bearing was allowed. During treatment, the patient experienced a minor pin-site infection, which responded to oral antibiotics. Six months after frame application, a CT scan was obtained to assess bony healing at the nonunion site, and then the external fixator was removed. A short-leg walking cast was applied. The patient was allowed toe-touch weight-bearing. Two weeks after cast application, the cast was replaced with a removable boot for 2 weeks. At that time, full weight-bearing was allowed. Two months after frame removal, the patient had full knee extension and flexion to 120°. However, his ankle range of motion was still limited (extension to approximately −5° from neutral). The patient attended physical therapy sessions to improve ankle range of motion. Two years after frame removal, he was able to dorsiflex his ankle to neutral. He has returned to working full time.