Tibialization of the fibula: a viable option to salvage limbs with extensive scarring and gap nonunions of the tibia.

I retrospectively reviewed 21 patients who had tibialization of the fibula for infected nonunions with scarring of soft tissues. Most of the patients had unsuccessfully had other operations to restore continuity of the tibia before this treatment. The prerequisites were adequate vascularity, an intact sensate sole, and intact fibula. Proximal site tibiofibular synostosis was done in all patients. Three patients required a supplementary procedure at the proximal tibiofibular junction because of screws cutting out. Distal tibiofibular synostosis was done as a second-stage procedure in a majority of the patients 3 to 6 weeks after the proximal procedure. Protected weightbearing was recommended for 4 to 8 months. The transplanted fibula hypertrophied and approached the diameter of the tibia (or double the size of original fibula) in 2-3 years. Tibialization of the fibula is a safe, nondestructive, salvage procedure for treating difficult infected nonunions of the tibia. It is a simple technique that can be done in hospitals with a moderate infrastructure. Despite scarring, shortening, and limitation of knee and ankle motion, the patients were satisfied to be able to take part in normal daily activities on their own. After the success of synostosis, all patients engaged in activities of daily living and during the followup of 4-14 years none developed stress fracture of the tibialized fibula.