08/07/2026
Trauma Surgery: How do you manage a catastrophic implant failure when resources are limited?
We recently treated a 29-year-old gentleman with a complex post-traumatic history: prior infected distal femur trauma leaving him with a stiff knee, followed by a mid-shaft tibia fracture managed elsewhere with medial plating.
He presented with a **non-union, an open wound, and a 90° tibia malalignment**-the plate had severely bent rather than snapping.
The Surgical Strategy
1. Debridement & Clearance: Extracted the bent plate, performed thorough soft-tissue debridement, opened the intramedullary canal, and elevated an osteo-periosteal flap. 2. Realignment & Fibular Osteotomy: Corrected the 90°
multiplanar deformity after fibular osteotomy.
3. The Biomechanical Solution: Standard interlocking nailing was ruled out due to his stiff knee. While an Ilizarov or LRS rail would be ideal on paper, working in a resource-limited setup required pragmatism.
We adapted by combining multiple intermediary TENS nails with an External Fixator to achieve stable fixation, correct alignment, and controlled compression.
Key Takeaway
Surgical excellence isn't about having an ideal setup; it's about applying sound biomechanical principles to do the absolute best for your patient with the resources at hand. It is incredibly rewarding to restore alignment and put this young patient back on the path to mobility.
To my seniors and colleagues: How would you have approached this case under similar constraints? We would love to hear your insights and experiences in the comments below.