Part 7 (13 October 2015) – Complex Lower Leg Injury with Significant Injury to the Knee Joint and Extensor Mechanism

Part 7 – 13 October 2015

Both legs have equal length. Distraction osteogenesis is completed. Patient is well in himself. Still pain in his leg and ankle, but less since stopped distraction. Pin sites are generally dry, clean, some discharge from few of them. Nothing to worry about at the moment.  Ankle is still stiff but is improving slowly (close to neutral dorsiflexion). Knee movement is from 0-95 deg. I am very happy with it. Recent inflammation markers were normal. This is excellent news.

‍​X-rays were impressive today with excellent regenerate in the distraction site (blue arrow) but even more surprisingly was new callus formation at the level of the compression site (yellow arrows). I certainly did not expect to see callus at this point. Expected few months later, if I am honest. I am very optimistic.

Excellent regenerate at the level of lengthening (blue arrow) and new callus formation at the level of the fracture compression (yellow arrows).

As I have only presented  X-rays recently I asked the patient if I can take few pictures to better present the soft tissues. Images are below.

Proximal rings and half pin pin site.

Plan:
  • Continue with physiotherapy to improve ankle movement.
  • Weight-bearing as tolerated.
  • Regular pin sites care.
  • Further follow up in 4 weeks.
  • Frame will have to stay on the leg for at least another 6 months (6cm regenerate). Hopefully the proximal fracture will heal by then.
Author:
I am a consultant orthopaedic trauma surgeon working at Addenbrooke's hospital, Cambridge University Hospitals NHS Foundation Trust.

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