case_images: PMC9957684_01
case_images: Evaluation visit photograph showing a left tibia with varus malalignment.
case_images: cureus-0015-00000034212-i01.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i01.jpg
case_images: FIG1
case_images: A 25-year-old female presented to our orthopaedic trauma service for evaluation of an infected left tibial shaft non-union with a 5 cm bone defect, 6 cm limb length discrepancy, and varus malalignment (Figures 1, 2).
case_images: (A) Anteroposterior and (B) lateral radiographs of a left tibia non-union demonstrating a significant bony defect with varus malalignment and diffuse osteopenia.
case_images: cureus-0015-00000034212-i02.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i02.jpg
case_images: FIG2
case_images: A 25-year-old female presented to our orthopaedic trauma service for evaluation of an infected left tibial shaft non-union with a 5 cm bone defect, 6 cm limb length discrepancy, and varus malalignment (Figures 1, 2).
case_images: CT angiography revealing occlusion of left anterior tibial artery near the level of defect.
case_images: cureus-0015-00000034212-i03.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i03.jpg
case_images: FIG3
case_images: CT angiography demonstrated complete occlusion of both her anterior and posterior tibial arteries (Figures 3, 4) at the level of the fracture and MRI revealed persistent tibial osteomyelitis. 
case_images: CT angiography revealing occlusion of left posterior tibial artery near the level of defect.
case_images: cureus-0015-00000034212-i04.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i04.jpg
case_images: FIG4
case_images: CT angiography demonstrated complete occlusion of both her anterior and posterior tibial arteries (Figures 3, 4) at the level of the fracture and MRI revealed persistent tibial osteomyelitis. 
case_images: Postoperative photographs of the patient's leg after placement of a cement spacer and external fixator.
case_images: cureus-0015-00000034212-i05.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i05.jpg
case_images: FIG5
case_images: She then underwent irrigation and debridement of the left tibia, placement of an antibiotic cement spacer, rectus abdominus free flap, and static external fixation (Figures 5, 6), with a plan to return to initiate bone transport after flap maturation.
case_images: Postoperative (A) anteroposterior and (B) lateral radiographs of the left tibia after placement of a cement spacer and external fixator.
case_images: cureus-0015-00000034212-i06.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i06.jpg
case_images: FIG6
case_images: She then underwent irrigation and debridement of the left tibia, placement of an antibiotic cement spacer, rectus abdominus free flap, and static external fixation (Figures 5, 6), with a plan to return to initiate bone transport after flap maturation.
case_images: Intra-operative fluoroscopic images demonstrating (A) anteroposterior and (B) lateral positioning of trial implants confirming adequate bony contact and alignment.
case_images: cureus-0015-00000034212-i07.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i07.jpg
case_images: FIG7
case_images: Using the blocking screw technique both proximal and distal to the segmental defect, an intramedullary nail was inserted and passed through the 3D-printed titanium mesh cage and statically locked (Figures 7, 8, 9).
case_images: (A) Anteroposterior and (B) lateral views showing reaming of the tibial shaft through the trial implant.
case_images: cureus-0015-00000034212-i08.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i08.jpg
case_images: FIG8
case_images: Using the blocking screw technique both proximal and distal to the segmental defect, an intramedullary nail was inserted and passed through the 3D-printed titanium mesh cage and statically locked (Figures 7, 8, 9).
case_images: (A) Proximal segment posterior blocking screw and (B) distal segment medial blocking screw ensuring optimal placement of intramedullary tibial nail.
case_images: cureus-0015-00000034212-i09.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i09.jpg
case_images: FIG9
case_images: Using the blocking screw technique both proximal and distal to the segmental defect, an intramedullary nail was inserted and passed through the 3D-printed titanium mesh cage and statically locked (Figures 7, 8, 9).
case_images: The patient was able to ambulate independently at the one-year follow-up.
case_images: cureus-0015-00000034212-i10.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i10.jpg
case_images: FIG10
case_images: At the one-year follow-up, the patient reported no pain and remained independent in ambulation using a custom ankle foot orthosis with lift for stabilization (Figure 10).
case_images: One-year postoperative (A) anteroposterior and (B) lateral radiographs of the left tibia demonstrating 3D-printed titanium implant and intramedullary nail with restored alignment and segmental bony defect.. 3D: three-dimensional
case_images: cureus-0015-00000034212-i11.jpg
case_images: PMC9957684_01_cureus-0015-00000034212-i11.jpg
case_images: FIG11
case_images: X-rays demonstrated intact hardware at both ends of the 3D implant (Figure 11).