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FIGURE 54.34
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A and B, Clinical photograph and initial radiograph of pedestrian struck by vehicle at high speed. Presented with Gustilo 3B open proximal fibular and tibial fractures. Note large bone defect. C and D, Fracture managed with multiplanar ring external fixator secondary to overlying soft-tissue injury requiring skin grafting. Osseous defect managed with bulk autogenous bone grafting and acute compression/shortening of fracture in wire frame after removal of large antibiotic spacer.

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