Case study

Use of STIMULAN in the treatment of comminuted distal tibial fracture

Courtesy of Prof. James B Richardson, RJAH Orthopaedic Hospital, Oswestry, UK

Clinical particulars

A 53 year-old male presented with a right ankle fracture.



An Ilizarov external fixator was fitted to the right leg with arthroscopic reconstruction of the right ankle joint. Schanz screws were inserted into the tibia proximally and into the tallus and calcaneus distally all under x-ray control. An articulated ankle and short body fixator was applied and the fracture was distracted.

One month following, decortication of the tibia was performed maintaining external continuity to the periosteum. Proximal extension of the wound was used to reveal the most proximal fracture site. STIMULAN was inserted and a transverse osteotomy was performed 3cm proximal to the ankle joint line (Figure 2). Following the insertion of threaded cancellous bone screws, the open wedge of the osteotomy was also packed with STIMULAN.



The patient stayed on high elevation for a week prior to mobilising again, weight bearing for a short period each day.

At 8 weeks x-ray show advanced absorption of STIMULAN with healing and callus formation evident. (Figure 3).

At 18 months x-ray show total absorption of STIMULAN and healing of the fracture site. (Figure 4).