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| At Presentation |
| 25 year old young man, had a bad
accident about 10 months back. The tibia was fractured in two places
(segmental fracture) with injury to the blood vessel and nerve. He
underwent a number of surgeries namely arterial grafting, muscle flap,
skin grafting, Ilizarov fixation before presenting to us with
discharging sinuses, inability to walk and lack of confidence. |
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| X-rays at Presentation |
| The x-rays showed nonunion at both
the upper and lower fracture sites. The lower fracture site showed
infection and dead bone. The fixator was not holding the bone fragments
in good alignment and the wires were all loose and some of them were
infected. |
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| PET Scan |
| The FDG PET Scan showing active
infection at the lower fracture site. An arterial DSA (Digital
Subtraction Angiogram) was done to determine the course and patency of
the arteries. |
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| Sequestrum – Dead Bone |
| The dead bone was excised. The
line of demarcation between the dead and viable bone is shown here in
the picture on the left (yellow arrow). |
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| In surgery the dead bone
(sequestrum) & all the infective tissue was removed. An
intra-medullary V-nail was applied to keep the bone aligned and
antibiotic loaded calcium sulphate pellets were instilled in the
proximal and distal fracture sites to control infection. |
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| 4 Weeks |
| The calcium sulphate pellets are
completely absorbed. The infection is settled and the sinuses healing
well. The upper fracture is showing signs of healing. |
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| Bone Transport |
| The Ilizarov fixator is applied
while the intra-medullary nail is still inside. An osteotomy was done in
the proximal aspect for the purpose of bone transport. |
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| 5 Weeks |
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