{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T22:45:32Z","timestamp":1776379532685,"version":"3.51.2"},"reference-count":11,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J R Army Med Corps"],"accepted":{"date-parts":[[2016,5,25]]},"published-print":{"date-parts":[[2016,12]]},"abstract":"<jats:p>Large tibial defects present a challenging scenario for the orthopaedic surgeon, particularly in the paediatric patient. Most management options, such as the vascularised fibular graft or Ilizarov technique, require microsurgical techniques or specialist equipment. In an austere environment, acute shortening or limb amputation may be most appropriate. However, limb salvage may be achieved by ipsilateral fibular transfer. In a one-stage operation, the fibular graft is harvested and either placed in the tibial defect in an intramedullary position or secured to the tibia with screws. We present two paediatric cases where this approach was used to preserve the lower limb despite extensive explosive trauma. In the first case, an 11\u2005cm tibial defect was managed with an ipsilateral fibular graft. The graft was placed in an intercalary position proximally, with medial displacement of the ankle and fixation of the fibula as a strut graft. In the second case, a 10\u2005cm tibial defect was managed with an ipsilateral fibular graft, using intercalary placement proximally and distally. Both children returned to weight bearing with crutches within several months of surgery. For large tibial defects, ipsilateral fibular transfer is an effective one-stage operation that represents a viable alternative to amputation in austere environments.<\/jats:p>","DOI":"10.1136\/jramc-2016-000665","type":"journal-article","created":{"date-parts":[[2016,7,22]],"date-time":"2016-07-22T23:23:22Z","timestamp":1469229802000},"page":"476-478","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Ipsilateral fibular transfer as a salvage procedure for large traumatic tibial defects in children in an austere environment"],"prefix":"10.1136","volume":"162","author":[{"given":"Andre J","family":"Keenan","sequence":"first","affiliation":[{"name":"Trauma and Orthopaedic Department, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"O J F","family":"Keenan","sequence":"additional","affiliation":[{"name":"Trauma and Orthopaedic Department, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C","family":"Tubb","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, Texas, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"M Wood","sequence":"additional","affiliation":[{"name":"Trauma and Orthopaedic Department, Institute of Naval Medicine, Gosport, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T","family":"Rowlands","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, RCDM, Birmingham, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S E","family":"Christensen","sequence":"additional","affiliation":[{"name":"Orthopaedic and Trauma Surgery, Danish Army, Nuuk, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,7,22]]},"reference":[{"key":"2025081314365429000_162.6.476.1","first-page":"1781","article-title":"Classification of type III (severe) open fractures relative to treatment and results","volume":"10","author":"Gustilo","year":"1987","journal-title":"Orthopedics"},{"key":"2025081314365429000_162.6.476.2","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.2106\/00004623-200207000-00022","article-title":"Blast and fragment injuries of the musculoskeletal system","volume":"84-A","author":"Covey","year":"2002","journal-title":"J Bone Joint Surg Am"},{"key":"2025081314365429000_162.6.476.3","doi-asserted-by":"publisher","DOI":"10.1007\/s10434-004-1162-4"},{"key":"2025081314365429000_162.6.476.4","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.91B2.21272"},{"key":"2025081314365429000_162.6.476.5","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1302\/0301-620X.63B2.7217150","article-title":"Vascular pedicle graft of the ipsilateral fibula for non-union of the tibia with a large defect. An experimental and clinical study","volume":"63-B","author":"Chacha","year":"1981","journal-title":"J Bone Joint Surg Br"},{"key":"2025081314365429000_162.6.476.6","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s11832-014-0618-8","article-title":"The Huntington procedure: still a reasonable option for large tibial defects in paediatric patients","volume":"8","author":"Gupta","year":"2014","journal-title":"J Child Orthop"},{"key":"2025081314365429000_162.6.476.7","first-page":"14","article-title":"Non-vascularized fibular strut grafting in management of bone defects","volume":"14","author":"Shah","year":"2015","journal-title":"Online J Health Allied Scs"},{"key":"2025081314365429000_162.6.476.8","doi-asserted-by":"crossref","unstructured":"Tuli SM . Tibialization of the fibula: a viable option to salvage limbs with extensive scarring and gap nonunions of the tibia. Clin Orthop Relat Res 2005; (431):80\u20134. doi:10.1097\/01.blo.0000152600.61198.d3","DOI":"10.1097\/01.blo.0000152600.61198.d3"},{"key":"2025081314365429000_162.6.476.9","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.K.01338"},{"key":"2025081314365429000_162.6.476.10","doi-asserted-by":"crossref","first-page":"653","DOI":"10.4103\/0019-5413.104197","article-title":"Gap nonunion of tibia treated by Huntington's procedure","volume":"46","author":"Kundu","year":"2012","journal-title":"Indian J Orthop"},{"key":"2025081314365429000_162.6.476.11","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-002-0378-9"}],"container-title":["Journal of the Royal Army Medical Corps"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jramc-2016-000665","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T21:37:03Z","timestamp":1755121023000},"score":1,"resource":{"primary":{"URL":"https:\/\/militaryhealth.bmj.com\/lookup\/doi\/10.1136\/jramc-2016-000665"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,7,22]]},"references-count":11,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2016,11,28]]},"published-print":{"date-parts":[[2016,12]]}},"alternative-id":["10.1136\/jramc-2016-000665"],"URL":"https:\/\/doi.org\/10.1136\/jramc-2016-000665","relation":{},"ISSN":["0035-8665","2052-0468"],"issn-type":[{"value":"0035-8665","type":"print"},{"value":"2052-0468","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,22]]}}}