Case 1 continued . .
Once we were sure that the infection was settled, (and the circumference of the leg reduced significantly), we went ahead with adding an ilizarov fixator to the limb, and doing a corticotomy in the proximal tibia.
There were two nonunions we were dealing with, one proximal in the midshaft, and another gap, distally.
The frame was constructed to allow continued compression across the proximal nonunion site (if you look closely, you will see the arced wires in the xrays and clinical pictures).
The corticotomy posed a challenge, with the nail already in, and the limb not really a good one to do a Gigli Saw osteotomy on.
After the a period of 10 days, distraction (transport) was begun. As the osteotomy site opened up, the gap at the lower nonunion closed.
Improving the Docking site
At one point, the two edges of the gap nonunion came into contact, and would have prevented a good cross section of bone for the healing. Therefore we did a percutaneous osteotomy and osteotomised, in situ the long beak of the proximal fragment such that it could now present a broader surface for the docking.
After docking was achieved, proximal lengthening was continued for a couple of centimetres to equalise his length.
The Gap nonunion healed without any bone grafting, the regenerate healed without any issues, and the patient has good function. No discharge.
I am told he will be getting married soon, and we will certainly celebrate with him.