Fifteen Month Followup.
Click images to enlarge.
Patient is 30 yo male 15 months status post severely comminutedtibia fracture (plateau, shaft, plafond) treated with ring fixator and freeflap - now one day s/p removal of the ring fixateur. The soft tissue envelopeis scarred but healed. Most of the fracture lines and fragments have healedbut there is gross motion 15 cm distal to the joint which was treated withbone graft and implantable electrical stimulator. The patient is partialweight bearing in a custom brace. Images obtained with Kodak DC50 digitalcamera.
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Nine MonthFollowup
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Date: Sun, 17 Nov 1996 16:22:29 -0600From: FRCSC@aol.comSubject: Re: Tibia fracture case 10-95 15 month followup 11-96
Suggestion for your 15 month old fx non-union.
1. If patient is amenable, do BKA.
2. If patient wants to pursue salvage, then do CT scan to more preciselymap out the non-unions (plural) and to plan approach for secondary reconstruction. Tools available include: bone transport, bone graft, resection shorteningrelengthening.
3. Your images posted in the web site are helpful, but still lackingin resolution...
John HERZENBERG, MD
Date: Mon, 10 Feb 1997 07:29:31 -0600Reply-To: ort-l@lists.missouri.eduFrom: Pedro <"ptucci@correionet.com.br"@correionet.com.br>
It seems to be easy to comment on a case like this. The real fact isthat we have a high-enegy fracture, 3B, with great devitalization even inthe first piture, and , if after 4 months you didn't achieve a good andsolid union, you have to change the "bed" of this new bone, withresection of all the fragments, non-economic debridement of soft tissueand double bone transportation by Ilizarov method, with 2 corticotomies;in this case there will be an improvement of the skin, revascularizationand a good compression at the fracture site.This is our experience, in caseslike yours. Now the same indication is valid, but the state of the kneeand ankle must be carefully analyzed and the BKA studied. Best regards,
PTUCCI