March 17, 2020

Part 4 - 11 August 2015

Written by Mr Matija Krkovic

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We are getting more problems (complications) recently but we are in the most crucial part of the job. This is certainly anticipated therefore follow ups in one week increments.
One of the slotted screws broke. doesn't happen very often but knowing that they are withholding 1000N force through the wire and compressing the wire (friction force between wire and the ring enables stability) to the ring to maintain the fixation is not a surprise. My estimate of torque required to fix a wire to the ring is in the range of 10-15Nm. It is certainly easier to mange than broken wire. Slotted bolt gets replaced with a new one and wire tension re-established the old fashion way - using spanners only.

Otherwise X-rays show progress as planned. Proximal fragment is moving into the mid fragment (yellow arrow) when distal corticotomy is getting bigger (another 7 mm since the last time, blue arrow). One of the expected complications (drawbacks) is tightening of the Achilles tendon due to the lengthening of the leg. Only physiotherapy can help at the moment but we will also slow down the distraction speed to 0.5mm per day as we have already reached 2cm of new bone and the risk of premature consolidation is smaller. But still can happen. Will keep an eye on it.

AP radiograph of the lower leg with proximal fragment going into the mid fragments (yellow arrow) and callus distraction gap (blue arrow) getting bigger.

Lateral radiograph of the lower leg with proximal fragment going into the mid fragments (yellow arrow) and callus distraction gap (blue arrow) getting bigger.

Plan for the next week:

  1. Continue with compression of proximal fracture (yellow arrow).
  2. Continue with the lengthening of distal corticotomy site with 0.5mm per day.
  3. In a week's time will correct apex posterior deformity between the proximal and the mid fragment.
  4. Active physiotherapy to stretch triceps muscle (Achilles tendon) and regain the ankle range of movement.
  5. Painkillers to help with the pain.

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