Joint-preserving reconstruction of a traumatic distal tibial defect using the Capanna technique: a case report

Abstract

Introduction and importance: Massive segmental bone defects constitute a complex therapeutic challenge. The most widely-accepted techniques to address such defects, i.e., distraction osteogenesis and vascularized bone grafts, are associated with significant limitations. The Capanna technique, which combined a structural allograft with a vascularized fibular graft, has emerged as an effective alternative for cancer patients. However, few reports exist on its use outside this context. The case presented here extends the indications of the Capanna technique to the traumatic scenario, where it can also allow preservation of the joint. Presentation of case: 63-year-old male with an open IIIC fracture of the right distal tibia also involving the ankle joint that was sustained in a high-energy motor vehicle accident. Following a damage-control surgery and a rectosigmoid tumor resection, the 12 cm bone defect was addressed by means of the Capanna technique. A structural tibia allograft was used in combination with a contralateral vascularized fibular graft, both of which were fixed with an anterolateral plate. Bone transport and arthrodesis were ruled out. The patient's clinical course was favorable, with healing of the graft and an acceptable outcome in terms of function and joint range of motion. Clinical discussion: This case highlights the versatility of the Capanna technique, showing that it can effectively be used outside the oncologic scenario, to address post-traumatic defects with joint involvement. Conclusion: Use of the Capanna technique without recourse to arthrodesis appears to be a valid alternative in the treatment of intra-articular post-traumatic bone defects.