Pseudoartrosi del III distale di gamba in grande anziano: correzione con apparato di Ilizarov e PRP

摘要

We present the case of a 78-years-old patient who had a distal tibia nonunion as a consequence of a car accident where the patient had a complex fracture of the distal third of the tibia. He was submitted to surgery that was performed in another hospital and consisted into an open reduction and an internal fixation with LCP plates positioned on the distal part of fibula and tibia. After one month the patient presented a skin dehiscence that lead to the exposition of the tibial plate. He undertook removal of the internal plates, application of an external fixator (Hoffman 2) and plastic surgery to remove the skin defect. After seven months the external fixator was removed and a plaster placed in its place. The patient came to our attention after one month because of growing pain and inability to deambulate. A distal tibial non-union was then diagnosed by submitting the patient to TC and scintigraphy. Surgery consisted in cleaning the nonunion area, in adding PRPs and in using external circular fixation (True Lock) with progressive compression for stabilization. The final compression length was 16 mm and full bearing was allowed 1 month after surgery. The fixator was kept by the patient for 11 months. After 5 months from removal of the fixator, the patient presents an active deambulation without pain, just using 1 cm of insole.