An Unusual Case of an Extensive Proximal Tibia Bone Defect Secondary to Complicated Cellulitis Managed by Unifocal Bone Transport Using an Ilizarov Fixator

Bone defects occur following bone loss secondary to trauma or due to infection. Extensive bone defects are usually seen in the former. It is unusual to have large defects in isolated osteomyelitis without prior history of any trauma. We are reporting a case with a bone defect of around 17 cm due to infectious aetiology and its management by unifocal bone transport using the Ilizarov ring fixator. Case Report The present report describes a 45-year-old gentleman with newly diagnosed diabetes mellitus who was initially admitted under general surgery for management of cellulitis and was later admitted under orthopedics for suspected osteomyelitis of left proximal tibia and septic arthritis of left knee. Serial debridement, prolonged antibiotic therapy and skeletal stabilization by a temporary joint spanning external fixator was applied to control the infection. The infection finally resolved after 6 weeks with a bone defect of approximately 17 cm. Options for reconstruction were discussed with the patient along with their pros and cons. Unifocal bone transport by ilizarov ring fixator was finalized with the patient’s consent with the aim of achieving a functional limb. Bone healing index was 1.17 months/cm. ASAMI scoring showed excellent bone result and good functional result. LEFS was 55/80. The lower scores were because of the fused knee. Conclusion To the best of the authors’ knowledge this is the largest defect secondary to infection without history of trauma which has been successfully treated by unifocal bone transport.