March 17, 2020

Part 5 (18 August 2015) - Complex Lower Leg injury with significant injury to the Knee joint and Extensor mechanism

Written by Dr Matija Krkovic

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Everything is going well. Still pain at the level of the mid shaft  tibia, not as much in the ankle joint. Pin sites dry and clean. On the X-rays below you can see that the proximal fragment is getting into the mid fragment as originally planned. Clinically it looks that we have achieved the "docking" point as majority of the struts are tight to the level where they cannot be turned anymore by bare hand. Another TSF prescription given to correct apex posterior deformity on the lateral view, but not compressed it anymore.


Due to the deformity, proximal ring is impinging on the skin. Skin is padded and protected, but further correction should remove ring from the skin. Hopefully. But it is difficult to predict due to the moving fragment around the place.
Distraction of the distal tibia is going well, good regenerate visible.

Ap view of the tibia with slightly bigger distraction gap (3.5mm since last time) (blue arrow) but proximal fragment's spike (yellow arrow) well into the intermediate fragment.

Lateral view of the tibia with slightly bigger distraction gap (3.5mm since last time) (blue arrow) but proximal fragment's spike (yellow arrow) well into the intermediate fragment.

Plan:

  1. Correct the apex posterior deformity on the lateral view using TSF software
  2. Continue with the slower distraction rate (0.5 mm per day) of the distal tibia corticotomy to minimise the force on the ankle joint
  3. Currently leg length discrepancy is under 1 inch. Will aim to get it inside 1 cm

Hopefully will hear from the patient and get some further images of the leg including pin sites.

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