Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table to allow for optimal access to the tibial shaft and application of the circular external fixator.

Anatomical surgical approach:  A percutaneous approach was utilized for the application of the Ilizarov fixator. Multiple transosseous wires and half-pins were inserted through the tibia, avoiding neurovascular structures, and connected to circular rings. Compression was applied at the pseudoarthrosis site, and a proximal corticotomy was performed for bone lengthening.

The surgeon noted that achieving adequate compression at the pseudoarthrosis site was critical for promoting union. The distraction osteogenesis was initiated at a rate of 1 mm per day to achieve the desired lengthening while monitoring for signs of regenerate formation and alignment.

Postoperative protocol:   Postoperatively, the patient was instructed on weight-bearing as tolerated with the assistance of crutches. Regular follow-up visits were scheduled to adjust the fixator and monitor bone healing and alignment. Physical therapy focused on maintaining joint mobility and muscle strength.

Follow up:   Not specified.

Orthopaedic implants used:   Ilizarov external fixator system.