Possibly an orthesis is still better for the patient - it depends on his personal priority. Nevertheless a well done below knee amputation works very well.

Sure, it will do the job. But, did you check for possible reasons, why you weren't successful until now? Diabetes? Peripheral Arterial Disease? Soft tissue damage? Neurological disorders? Hyperparathyroidism? Vitamin D deficiency? Infected non-union? Hereditary disorders? Is there anything you might improve?

Thank you, dear colleagues, for your answers. I also think that a below knee amputation is a good solution after years of unsuccessful surgeries. As far as the questions of Dr. Schmal are concerned, none of the mentioned conditions are present. Probably, this is the dreadful locus (passage of middle to distal third of tibia that has poor vascularization a priori, especially when a. nutricia is damaged ) to blame, accompanied by multiple surgeries (not very well planned and executed ?).

Dear Colleagues, at what age did the fracture occure and what is the age of the person at present? If it happend in early child age and was developed on a congenital bowing of the leg, the possibility to perform a successful trans-tibial amputation will depend on the actual age/expected further growth of the person.

Could you consider acute shortening to find healthy bone and then subsequent bone transport to restore length?

Below knee amputation is the best solution after years of unsuccessful surgeries. Amputation improves quality of life in these cases. 

After all that effort to preserve the injured lower limb, amputation is a great functional option for sure. First of all, as Dr Schaml well said, investigation about the reason you weren't successful until now is very important (comorbidities etc), even to choose the best level of amputation. In my routine I see great outcomes followed by transtibial amputation (BKA). If there is length enough, the Ertl bone bridge technique is a good option too, specially if it is a young patient. Quoting Dr Bytyqi: "Amputation improves quality of life in these cases".

Article Cortical tibial osteoperiosteal flap technique to achieve bo...

Dear Colleagues

I agree to Hagen. In this case, amputation is a viable option. But, amputation surgery is not that exciting - I would like to find out the reason for all that failures and to learn how to prevent such cases.

The attitude of “Save all extremities at all costs” indeed causes increased morbidity  in a severely injured extremity or in a nonunion. The patients who had amputation had better functional outcome in terms of being able to do their activities of daily living and getting back to pre-injury occupation, compared to patients who had their limb salvage. 

Reference-DOI: 10.5455/2349-3259.ijct20140811

It is very important to find out the reasons for failure but in the end below the knee amputation after an unhappy case of long standing tibia non - union is an appropriate option for patients with recalcitrant non - union of tibia.