Reconstruction of Distal Tibia Bone Loss by Intercalary Distal Tibial Allograft and Stabilization Using Anterograde Tibiotalar Intramedullary Nailing: Technical Note and Case Report

Introduction: The difficulties of managing bone loss in the distal tibia are well known in the literature. The various therapeutic options available to us include custom prosthetic replacement, talocrural arthrodesis with allograft, vascularized or non-vascularized autograft, bone transfer according to Ilizarov and insertion of a metal augment. In the case of non-conservation of the talocrural joint, osteosynthesis is performed using adapted plates and screws or, more conventionally, transplanted centromedullary nailing. We report on a clinical case of bone loss in the distal tibia in an infectious context, using an innovating talocrural arthrodesis reconstruction technique with allograft insertion at the level of the bone defect. Fixation was achieved with an anterograde tibiotalar nailing, which enabled preservation of the subtalar joint and compliance with the biomechanical principles of stable fixation. Case Report: We report the clinical case of a 40-year-old patient with osteitis of the distal tibia following open trauma which required multiple surgeries of the osteosynthesis and cover flap type. The uncontrolled infection and skin fistulation led to a two-stage operation. The first stage consisted of resection of 9 cm of infarcted distal tibia, bacteriological samples were also taken, a cement spacer was inserted, temporary fixation was provided by an external fixator, and appropriate antibiotic therapy was administered for a period of 3 months. The second stage of the operation took place 6 weeks after the first and consisted of reconstruction using an intercalary distal tibial allograft and stabilization using an anterograde tibiotalar centromedullary nailing with stable static fixation. Demineralized bone matrix (DBM) was placed at the native bone-allograft junction. The patient’s fellow-up is 9 years, the complete bypass has been achieved with consolidation, the subtalar joint is preserved, and the viability of the construct is maintained. Conclusion: Anterograde tibiotalar centromedullary nailing is a stable and reliable method of fixation in the management of distal tibial bone defects with talocrural arthrodesis. Keywords: Distal tibial bone defect, infection, allograft, anterograde intramedullary nailing.