Modification of Huntington’s Procedure In The Tibialization of the Fibular in Awka, Anambra State Nigeria-A Report of Cases of Infected Non Union and Acute Trauma with Tibia Loss

Abstract

Tibialization of the fibularis a procedure that requires medialization of the fibular in whole or in part to replace the function of the tibia. This could be as a result of large tibia defect due to trauma, infection or congenital loss. We report two cases of tibialization of the fibularby modifying the Huntington's procedure. Only one stage of the procedure was used to tibialize one end of the fibular in each case and then the outcome observed. Patient A is a 32year old man who hadinfected fragments of remaining right tibiafollowing gunshot injury a year prior to presentation. He underwent excision of sinus riddled skin and scars and excision of the infected segment, and tibialization of the proximal end of the fibular to the distal end of the proximal tibia prepared for it while still maintaining its natural articulation on the distal tibiofibular joint. He also had flap cover and skin grafting. Tibialization and fibular hypertrophy was noted over 1year to4year period. Patient B is a 50year old woman who was a victim of motorcycle crash. She sustained Gustillo and Anderson type 3B open distal lefttibia fracture withmuscle andskin loss. She was resuscitated and underwent an emergency tibialization of the fibular, had muscle advancement flap cover and skin grafting.Follow up for 3years showed fibular hypertrophy and painless ambulation. Conclusion: Modification of Huntington's procedure is effective in the treatment of tibial bone gap.