Periarticular Distal Tibial Infected Nonunion, Ankle Salvage with Bone Transport

This case outlines a staged approach to a patient status post open reduction internal fixation (ORIF) of a tibial pilon fracture with infection, bone loss, and soft tissue compromise. The soft tissue management in this case dictates the approach and extent for reconstruction. Our plan involved careful exposure through compromised soft tissue, removal of all nonviable tissue (bone and hardware), and stabilization (circular ring external fixation). The decision for ankle salvage versus arthrodesis is made based on the viability of the small tibial plafond segment and the condition of the tibiotalar joint. Residual limb length discrepancy was corrected through an integrated fixation method: lengthening with a computerized, six-axis, circular external fixator and then insertion of an intramedullary nail, as part of the second stage reconstruction.