Introduction: Resistant and refractory non-union of distal tibia extra-articular fractures is very common even following internal fixation due to poor blood supply to the distal tibia metaphyseal region. The management can be challenging.
Case report: A 50-year-old diabetic male had sustained closed distal tibia extra-articular fracture at the junction of diaphysis and metaphysis. Intramedullary interlocking nailing was done elsewhere. The fracture did not unite. Nail removal, bone grafting, and plate fixation were done elsewhere. The fracture did not unite and implant failure occurred. The nonunion was successfully managed by plate removal, intramedullary free fibula bone grafting, and Ilizarov fixation. Union required 6 months but patient finally was able to return to his work with good function and without any signs of infection.
Conclusion: This case illustrates the successful incorporation of a stabilized intramedullary fibula graft which enabled union of a resistant distal tibia fracture nonunion.
Keywords: Resistant tibia non-union; avascular fibular strut graft; distal tibia non union; ilizarov fixation.
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