Fig. 2

Case 2. A 49-year-old male patient with multiple open fractures of the right tibia and fibula (Gustilo grade II) due to a traffic accident underwent emergency debridement and internal fixation in a local hospital for half a year. Deep infection occurred after the operation, which was still uncontrollable after three times of debridement. Sinus tract was observed on the medial side of the lower extremity with pus (a). X-ray showed the tibia and fibula defect and sclerosis in part edge (b). Extended debridement, internal fixator removal, infected bone segment excision (approximately 9 cm), external fixation, tibiofibular shortening, distal tibial osteotomy, and full-thickness skin grafting were performed (c–f). At 1 week after operation, the wounds healed well, and the skin graft survived (g). Postoperative X-ray showed the tibial defects with good alignment (h). At 4 months after bone transport, the bone ends were contacted and the patient began weight-bearing walk (i). At 13 months after the operation, bone fracture healed well, and the external fixator was removed to restore normal walking function. (j–l). After 24 months of operation, the ASAMI functional score of the affected extremity was excellent, with an external fixation index 1.44