nonunion tibia managed with ALFA fixator

Orthopaedic Slide

1. Management of Infected Gap non union Tibia with ALFA Fixator Dr. Vikram Khanna D.Orth, DNB Orth. Fellowship in Ilizarov and Reconstructive Surgeries, CLLR, Mumbai Orthopaedic Consultant Aakash Healthcare and Super Speciality Hospital, Delhi Orthopaedic Consultant Sparsh Orthopaedics and Sports Injury Centre, Delhi & Gurugram

2. Presentation A 28 year old male patient came with discharging sinus from the middle third leg. XRays showed Nonunion fracture of tibia with shortening with intramedullary nail in situ. Patient had a blast injury 1 year back which was managed with external fixation then cast application

3. Nail removal + Debridement + Oblique fibular osteotomy + ALFA fixator application Plan acute docking and Lengthening with distal osteotomy.

4. Immediate postop Xray

5. Problems At the time of tightening the screw the screw head became loose Replaced the screw with another screw The allen key broke on tightening hard. Had to leave the clamp little loose Tightened it the next day once received another Allen key

6. Distraction started - Discharge from the non union site

7. Reasons Inadequate debridement Soft tissue interposition Loose clamp Persisting infection Poor soft tissue vascular status Poor alignment AP

8. Debridement done again and skin and soft tissue debrided at the non union site and fracture compressed

9. Attempted to correct alignment….but not successful

10. What next

11. Thank you