Date: Tue, 8 Jan 2002 22:12:21 +0530

Subject: Failed Plate fixation

32 year old manual labourer sustainal closed fracture lower 1/3rd Tibia in June 2001 and was treated elsewhere. Today he comes to me with painful limping. Clinically there is local tenderness and mobility at fracture site. Serial Xrays are attached.

Postop 1
Postop 2

(Sorry for the poor Quality of last Xray taken today which shows Broken screws. Please suggest further management.

? removal of implants, bone grafting and pop walking cast seems to me the safer option.

Thanking u

Yours sincerely

Dr. Sathis Chandran
Koyili Hospital
Kerala, India.

Reply at: Orthopaedic Trauma Association forum

Date: Wed, 09 Jan 2002 09:36:56 -0500

From: William Obremsky

The alignment looks good in the AP and lateral views, and the fx appears to be trying to heal w/ posterior callus. Why did it not heal? Does he smoke?, Big dissection and soft tissus stripping w/ this big plate? Too early weight bearing? I would vote for giving it a chance to heal in cast or protected weight bearing before complete failure occurs.

You could also add external electrical stim (PEMF) if you have that available. My guess is that this laborer is reluctant to have another operation.

Good Luck

Bill Obremskey MD MPH
Univ. of North Carolina