Tibialization of Fibula in an Implant Failure Non-Union Poliotic Limb - Case Report

Sep 29, 2026

Non-union of long-bone fractures, particularly the tibia, poses major challenges due to poor vascularity, limited soft-tissue coverage, and risks such as implant failure or infection after prior surgeries. Fibular tibialization is a viable but underreported technique. The case details a 26-year-old man with poliomyelitis and left tibial non-union after implant failure, treated with the Huntington method, achieving proximal tibiofibular union at 6 months and functional mobility recovery.

LanguageEnglish

CategoryHealthcare

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Pages5

Reading Time13 min

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Case Report Journal of Orthopaedic Case Reports 2025 December:15( 12) :Page 108-112 Tibialization of Fibula in an Implant Failure Non-Union PolioticLimb: A Case Report Sajal Maingi1, Pritam Samanta2, Simarjot Singh Sodhi3, Rajesh Kumar Chopra4 Learning Point of the Article: Fibular tibialization is an effective, low-complexity technique for managing complex tibial non-union, especially in cases with compromised bone stock, providing a viable limb salvage option with minimal implant use and promising functional outcomes. Abstract Introduction: Non-union of long bone fractures, particularly of the tibia, presents considerable challenges due to poor vascularity, minimal softtissue coverage, and complications such as implant failure or infection from previous surgeries. Tibialization of the fibula remains a viable, though underreported,techniquefor addressing such complex cases. Case Report: We report a case of a 26-year-old male with a history ofpoliomyelitis who presented with non-union of the left tibia following implant failure. Clinical evaluation revealed 4 cm limb shortening and varus deformity. Radiographs showed a broken 4.5 mm limited contact dynamic compression plate and multiple loosened screws. Given the intact fibula and adequate vascular and soft-tissue status, the Huntington method for tibializationwas selected. The surgical approach included implant removal, debridement ofnon-union margins, and medial transfer of the fibula using anterolateral and lateral approaches. Postoperatively, the patient experienced transient vascular compromise, which resolved without intervention. At 6months, radiographs confirmed proximal tibiofibular union, and the patient had regained functional mobility. Conclusion: Fibular tibialization using the Huntington procedure offers a low-complexity, implant-sparing solution for managing tibial nonunion, especially in patients with compromised bone and soft-tissue conditions. This case demonstrates favorable outcomes with minimal complications. Keywords: Tibial non-union, fibular tibialization, Huntington procedure, implant failure, poliomyelitis, limb reconstruction. Introduction Tibialization of the fibula is a time-tested procedure for managing tibial non-union, first popularized by Huntington [1] in 1904. This technique uses the fibula as a weight-bearing bone between the proximal and distal tibial segments. The weightbearing axis transfers forces from the proximal tibia through the fibula, maintaining its vascular pedicle derived from the peroneal artery, and into the distal tibia, leading to tibiofibular synostosis. Despite its sound mechanical and biological principles, this technique requires expertise, particularly in vascularized graft harvesting, often involving a steep learning curve and complex plastic surgical interventions. Dr. Tuli [2] introduced a modified “trap door” technique, wherein the proximal non-union edge of the tibia is freshened, and a trapdoor-like entry is created at the proximal tibial segment. The fibula is then transected and medialized into the proximal tibia’s medullary canal. A second-stage procedure, performed after 3–6 weeks, involves creating a similar trapdoor |
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Website: [www.jocr.co.in](www.jocr.co.in)

DOI:
[https://doi.org/10.13107/jocr.2025.v15.i12.6470](https://doi.org/10.13107/jocr.2025.v15.i12.6470) | Author’s Photo Gallery | | | | | --- | --- | --- | --- | --- | | | | |
Dr. Simarjot Singh Sodhi |
Dr. Rajesh Kumar Chopra | | |
1Department of Orthopaedics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India, 2Department of Orthopaedics, Apollo Multispecialty Hospitals, Kolkata, West Bengal, India, 3Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India, 4Department of Orthopaedics, ESIC Medical College and Hospital, Faridabad, Haryana, India.
Address of Correspondence:
Dr. Sajal Maingi,
Depar

FAQs

What is fibular tibialization used for in tibial non-union?

Fibular tibialization uses the fibula as a vascularized weight-bearing construct between tibial segments, aiming to treat complex tibial non-union while minimizing implants.

Who is described in the case report and what complications were present?

A 26-year-old male with poliomyelitis had left tibial non-union following implant failure, with limb shortening, varus deformity, and imaging showing a broken plate and loosened screws.

What outcome was achieved after treatment with the Huntington method?

The patient experienced transient vascular compromise that resolved without intervention, and at 6 months radiographs confirmed proximal tibiofibular union with regained functional mobility.

Sep 29, 2026

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