A 28-year-old man has an infected non-union of the mid-tibia with a 9 cm segmental bone defect after debridement. The skin envelope is stable and the ankle and knee joints are mobile. The most appropriate reconstructive option is:
- A Ilizarov trifocal bone transport with bifocal compression-distraction ✓
- B Massive cancellous bone grafting with plating
- C Below-knee amputation
- D Free vascularised fibular graft alone
Correct answer: A. Ilizarov trifocal bone transport with bifocal compression-distraction
Explanation
Segmental defects larger than about 5 to 6 cm are best managed by bone transport. In trifocal osteosynthesis one focus compresses the non-union site while two corticotomies generate transport segments that close the defect, simultaneously restoring length. Cancellous grafting cannot bridge 9 cm, amputation is unwarranted with a stable envelope and mobile joints, and a free fibular flap alone does not address infection control or simultaneous lengthening as effectively.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.