Salvage of Complex Bimalleolar Ankle Fracture Non-union after Failed Tibiotalocalcaneal and Charnley Arthrodesis using Fibular Strut Grafting and Ilizarov Fixation: A Case Report.

Introduction: Non-union following ankle fractures is uncommon but can result in significant pain and functional impairment when it occurs. Management becomes particularly challenging after failure of internal fixation and subsequent salvage procedures such as tibiotalocalcaneal (TTC) and Charnley compression arthrodesis. Circular external fixation combined with biological augmentation may offer a limb-salvage option in such complex scenarios. Case Report: A 39-year-old male presented with persistent pain and inability to bear weight following a bimalleolar ankle fracture initially treated with open reduction and internal fixation at an outside hospital. He developed established non-union and subsequently underwent TTC arthrodesis and Charnley compression arthrodesis at an outside institution; however, both procedures failed to achieve fusion. In view of persistent symptoms and aseptic non-union, limb salvage was undertaken using an autologous fibular strut graft combined with Ilizarov circular external fixation. Progressive consolidation was achieved, and the frame was removed after 6 months. At 1-year follow-up, the patient was pain-free, ambulatory without support, and radiographs confirmed solid union with maintained alignment. Conclusion: This case demonstrates that even after failed internal fixation and failed arthrodesis, limb salvage is achievable in complex ankle fracture non-unions. The combination of fibular strut grafting and Ilizarov circular external fixation provides a reliable mechanical and biological solution and should be considered in selected young, high-demand patients before amputation.