Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table to allow access to the lateral aspect of the lower leg for fibular intervention.

Anatomical surgical approach:  A lateral approach to the fibula was utilized. An incision was made overlying the fibula, followed by careful dissection to expose the infected bone. Radical debridement was performed to remove all necrotic and infected tissue. Antibiotic-impregnated bone cement beads were placed within the debrided area.

During the second stage, the bone cement beads were removed, and an intramedullary nail was inserted into the fibula for definitive stabilization. A bone cement spacer was also placed to maintain limb length and alignment. A protective external fixator was applied to provide additional stability and facilitate ankle arthrodiastasis.

Postoperative protocol:   Postoperatively, the patient was managed with a protective external fixator for 6 weeks to ensure stability and promote healing. The fixator was removed at 6 weeks, and the intramedullary nail was scheduled for removal at 12 months post-surgery.

Follow up:   Not specified.

Orthopaedic implants used:   Antibiotic-laden bone cement beads, intramedullary nail, bone cement spacer, external fixator.