Segmental bone loss of the tibia remains a significant reconstructive challenge, particularly in low-resource environments where access to advanced orthopedic care is limited. Multiple surgical approaches have been developed. Medial transposition of the fibula, “tibialization”, offers a structurally stable and biologically active solution, particularly for children with ongoing growth potential and strong regenerative capacity. We describe a case of an 8-year-old boy who sustained a 4 cm segmental defect of the proximal tibia following chronic osteomyelitis secondary to a snake bite. Reconstruction of the tibial defect was accomplished using a pedicled vascularized fibular flap, transposed medially into the tibial defect. Post-operative rehabilitation progressed gradually, with the patient eventually achieving satisfactory graft incorporation and limb function.

Keywords: Tibial defect, fibular tibialization, pedicled flap, pediatric bone reconstruction,limb salvage.