Reconstructive Challenges of Distal Tibia Bone Tumors: Extracorporeally Irradiated Autograft Combined with a Nonvascularized Autograft Fibula for Superior Reconstruction and Functional Outcomes When Compared to Ipsilateral Pedicled Fibula Transfer Alone

Figure 1

A 13-year-old female presented with a biopsy-proven distal tibia osteosarcoma (a), and following neoadjuvant chemotherapy, she underwent resection of the tumor (b) and reconstruction with centralization of ipsilateral fibula as a vascular graft (c). The midline incision was extended medially for plating across the ankle (d), and this posed a challenge with inadequate soft tissue cover over the reconstruction and led to a sinus formation. Plate breakage was observed at 39 months along with fibular hypertrophy and nonunion across the proximal junction (e), and this required bone grafting and plate exchange (f) to achieve union.

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