Acute Shortening and Then Lengthening for Type IIIB Open Adolescent Tibia and Fibula Shaft Fractures with Segmental Tissue Loss

A 13-year-old boy had type IIIB open tibia and fibula fractures with segmental anterior compartment tissue loss. He underwent an initial damage control strategy with debridement, irrigation, external fixation, and negative-pressure wound therapy. He then underwent two-stage reconstruction. Initial stage involved anatomic fixation of the tibia, excision of 5 cm nonviable bone, and primary repair of the anterior compartment musculature and skin. Second stage involved lengtheningLengthening 5 cm through a proximal corticotomyCorticotomy to restore length.