Date: Tue, 2 Sep 2003 10:48:39 +0200
From: Alo Kullerkann
Subject: Tibial bone loss
I would like to discuss on next fracture.
44 y/o male had bilateral shin crushed. Left Gustilo II open fx and right Gustilo IIIA open fx. Both nailed (unreamed) same day.
My concern is right tibia which shows more than 50% cortical loss. I removed bald 5x1 cm cortical fragment during surgery and there is also fragment diastasis at the fracture.
Wounds are healing uneventually, secondary wound closure was performed on POP day 3.
As I look at right tibia x-ray I presume this bone is not going to heal. My plan is to performe scheduled posterolateral auologous bone grafting at 8 weeks.
Question is whether to exchange nail to reamed (and shorter :-)) one or not. Or if there is lousy healing it would be enough to perform exchange nailing without additional open bonegrafting?
Alo Kullerkann, MD.
Mustame Hospital, Tallinn
Date: Wed, 3 Sep 2003 09:29:30 +0600
From: Alexander Chelnokov
AK> As I look at right tibia x-ray I presume this bone is not going to heal. My plan is to performe scheduled posterolateral auologous bone grafting at 8 weeks.
I wouldn't hurry with next procedures, good callus response can be still expected, so exchange nailing with thicker nail may be postponed to 3-4 month.
Date: Wed, 3 Sep 2003 23:59:38 EDT
Right tibia healing is going to be problematic.
I would give the soft tissue time to heal and try to be sure infection has not developed. Then as you were considering, bone graft. I would not exchange nail without grafting in this fracture.
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: Thurs, 4 Sep 2003 12:05 PM EDT
From: Bill Burman
In J Orthop Trauma. 1998 Mar-Apr;12(3):206-13, Moed et al published "Ultrasound for the early diagnosis of tibial fracture healing after static interlocked nailing without reaming: clinical results".
An ultrasound at 6 weeks post injury predicted the need for further intervention (e.g. bone graft, exchange nail, etc) . Have others found this useful in deciding subsequent treatment?