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Fig. 1

The 67 year-old male sustained comminuted open fracture of the right distal tibia and fibula (Gustilo III-c type) with soft tissue defect by traffic accident. External fixation was done, but delayed soft tissue coverage, then developed infected nonunion with chronic osteomyelitis according to Paley classification at postoperative 5 months.

(A) Roentgenograms showed nonunion tibia with soft tissue defect.

(B) The free flap of latissimus dorsi applied to soft tissue defect site.

(C) After radical excision of all necrotic tissue, applied bifocal Ilizarov frame with acute shortening of 6cm in length and inserted vancomycin beads.

(D) Follow-up study at eight months after operation with Ilizarov technique showed consolidation of regenerates and union of docking site.

(E) Roentgenograms fifteen months after operation showed excellent bone and functional result.

Fig. 2

The 27 year-old male sustained comminuted open fracture of the right tibia and fibula (Gustilo III-c type) with soft tissue defect by traffic accident. We couldn't check posterior tibial artery pulsation in ankle area. Closed reduction and external fixation was done, because unstable vital condition. Then developed infected nonunion with chronic osteomyelitis according to Paley classification at postoperative 3 months.

(A) Roentgenograms showed comminuted tibia and fibular fracture.

(B) Closed reduction and external fixation was done in emergency operation.

(C) Then developed infected nonunion with soft tissue defect after 3 months.

(D) After radical excision of all necrotic tissue, applied bifocal Ilizarov frame with acute shortening of 5 cm in length.

(E) Follow-up study at 10 months after operation with Ilizarov technique showed consolidation of regenerates and union of docking site.

(F) Roentgenograms 16 months after operation showed excellent bone result and good functional result.

Fig. 3

The healing index of proximal location show shorter than other site (p=0.038).

Fig. 4

The bone and functional result of proximal location show better than other site (p=0.025, p=0.03).

Fig. 5

The healing index of group A show shorter than group B (p=0.015).

Fig. 6

The bone and functional result of group A show better than group B (p=0.025, p=0.015).

Figure & Data

REFERENCES

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