Bone Transport to a Knee Fusion and Secondary Intramedullary Nailing s/p Gunshot Wound

A 33 year old woman sustained a close range shotgun injury to her left proximal tibia. This resulted in a large medial wound with significant bone loss without neurovascular injury. She was treated in a delayed fashion with an open reduction and internal fixation using medial and lateral locking plates. A severe infection developed requiring plate removal and extensive debridement resulting in an 11 cm bone defect. A complex circular frame was placed and the bone loss was reconstructed with bone transport using both femoral and tibial corticotomies to a knee fusion. Following docking and bone grafting, the frame was removed with immediate conversion to a customized intramedullary fusion nail. The patient resolved the infection, healed the regenerate segments and the knee fusion, and is currently ambulating with equal leg lengths without assistive devices.