Eleven patients (10 men and 1 woman) with a mean age of 32 years (range: 16-61 years) and a mean follow-up of 12 years (range: 2-21 years) were studied retrospectively after ipsilateral fibular transposition. The cause of tibial nonunion was a motor vehicle collision (MVC) in eight patients, a fall from a window in one, an adamantinoma in one, and osteomyelitis in one. There was one type I and eight type IIIb open fractures according to the Gustilo classification, and the nonunion was infected in seven patients. Healing of the tibial defect was obtained in eight patients, after a mean interval of 10.5 months. In the patient with the adamantinoma, resection of the tumour left a 22 cm defect in the tibia. Two patients required amputation for acute local infection. Seven of the eight patients in whom tibial union was achieved were able to walk with no aids. The authors conclude that transposition of the ipsilateral fibula is a valuable component of the therapeutic armamentarium and a salvage procedure for patients with multi-operated, infected or uninfected, tibial nonunion.
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