Distraction of Hypertrophic Nonunion

A 51 year old woman with rheumatoid arthritis had a closed fracture of her right tibia after a motor vehicle accident. One year after the accident, she had a severe varus and procurvatum tibial deformity and reported difficulty ambulating. The apex of the deformity had minimal mobility. External fixation was applied and used to slowly distract the hypertrophic nonunion. After 8 months, the external fixation was removed. The patient experienced one minor pin tract infection, which was managed with oral antibiotics. After external fixation removal, the patient ambulated (partial weight-bearing) with a walker for a month. Weight-bearing was advanced as tolerated, and the patient achieved full weight-bearing at the end of the month.