Distal tibial periarticular nonunions: ankle salvage with bone transport.

A nonunion of the distal tibial metaphysis in close proximity to the articular surface is a challenging clinical problem. Many of the commonly used techniques in a surgeon's treatment armamentarium can be ineffective because of the relative lack of distal bone stock. This study describes a technique of en bloc excision of all infected or nonunited distal tibial bone with an application of a circular external fixator and limb shortening. After treatment with parental antibiotics, when appropriate, and docking of the distal excision site, distraction osteogenesis of the proximal tibia is performed with a second circular frame.