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CASE REPORT
Year : 2020  |  Volume : 4  |  Issue : 1  |  Page : 42-51

Two-stage bone lengthening of the tibia through a normal bone and consolidated regenerate bone after trauma: A case report and literature review


Department of Trauma and Orthopaedic Surgery, Al-Essra Hospital, Amman, Jordan

Correspondence Address:
Dr. Akram D Al-Shoubaki
Department of Trauma and Orthopaedic Surgery, Al-Essra Hospital Outpatient Clinics (Level 3), Al-Essra Hospital, Queen Rania Street, Amman
Jordan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmsr.jmsr_116_19

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We report a case of two-stage leg lengthening of the tibia through the normal tibial bone followed by a 2nd stage lengthening through the consolidated regenerate bone using Ilizarov external fixator. A 10-year-old boy presented with multiple fractures, including a Gustilo IIIC open tibial fracture with neurovascular injury and 11 cm bone defect. Surgical debridement and acute shortening using a triangular external fixator were performed. After wounds healing, this was replaced by an Ilizarov circular frame, with a proximal tibial osteotomy performed to start distraction osteogenesis. Leg lengthening of 5.9 cm was achieved after 10.5 months of total external fixator time. Fourteen months after first frame removal, a 2nd stage leg lengthening was performed with an Ilizarov circular frame through an osteotomy of the consolidated regenerate bone in the proximal tibia to achieve further 6.1 cm leg lengthening after 6.2 months of total external fixator time. The second leg lengthening stage united faster than the first stage with reduced external fixator time and index. The patient had a good functional outcome assessed by the Association for the Study and Application of the Methods of Ilizarov criteria at 6 months' follow-up. A literature review was performed for a proposed research question about the treatment of such cases shows that this method is an acceptable way of treatment. To the best of our knowledge, there are no cases reported in English literature that reports a 2nd stage leg lengthening of the tibia through the consolidated regenerate bone after a first stage leg-lengthening for treatment of open tibial fracture with bone loss.


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