Date: Sat, 28 Aug 2004 14:55:17 +0600

From: Alexander Chelnokov

Subject: Distal tibia/fibula malunion

Hello All,

Dear colleagues,

A female 56 y.o. 6 weeks ago sustained a fracture of the distal tibia/fibula. At the initial hospital a plaster cast was applied. Now she was referred to our unit. At the moment there is no pain, no obvious mobility. Images and CT attached.

What is the best option here? Mobilize the fracture, perform open reduction and internal or external fixation? Or just to cut the anterior spike over the talar neck? THX in advance.

Best regards,

Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia

Date: Sat, 28 Aug 2004 15:54:17 EDT

From: Aobonedoc

It appears healed. Stated to be painless. I would leave it alone until something hurts.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
1100 W. Central Road, Suite 304
Arlington Heights, Illinois 60005

Date: Sat, 28 Aug 2004 19:42:52 EDT

From: Tadabq

I like the suggestions of leaving it alone or excising the anterior bone that might impinge upon the talus. Taking it apart could turn into a disappointing exercise in futility.

TD

Date: Wed, 1 Sep 2004 00:30:33 +0600

From: Alexander Chelnokov

THX to you and all who commented the case. Yesterday the spike was excised through anteromedial approach. Image attached.

Best regards,

Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia