Ilizarov correction of extreme anterior tibial bowing (≈100°) secondary to fibrous dysplasia: a case report from Afghanistan.

Introduction: Severe anterior tibial bowing due to fibrous dysplasia is rare and presents major reconstructive challenges. Taylor Spatial Frame, though ideal for such complex deformities, is currently unavailable in Afghanistan. This report describes the successful correction of a 96° anterior tibial bow with distal medial rotation and 5-cm shortening using the asymmetric lengthening technique of an Ilizarov ring fixator to achieve simultaneous angular realignment and limb-length restoration in an adult patient. Case presentation: A 22-year-old male presented with a severe saber-shin deformity of the left tibia (angulation ≈ 100°) secondary to fibrous dysplasia, accompanied by a 5-cm limb-length discrepancy. Two tibial osteotomies were performed proximal and distal to the apex of the deformity. An Ilizarov ring construct was applied without hinge mechanisms, instead employing asymmetric distraction for gradual correction. Over a period of progressive adjustment, satisfactory realignment and near-complete limb-length equalization were achieved. Both osteotomy sites consolidated uneventfully, and at the latest follow-up, the patient was pain-free and fully weight-bearing. Discussion: Bone deformity is a recognized complication of monostotic fibrous dysplasia. Asymmetric lengthening allowed simultaneous multiaxial angular correction and lengthening, overcoming the limitations of hinge-based systems. While the Taylor Spatial Frame offers precision, its high cost and unavailability make it impractical in resource-limited settings. Conclusion: This case demonstrates that even extreme anterior tibial bowing secondary to fibrous dysplasia can be effectively managed with a hingeless Ilizarov modification, providing a practical and low-cost alternative for complex deformity correction.