Another question for Dr. Berg
June 27, 2011 | 20,00 EUR | answered by Dr. med. Ralf Berg
Hello Dr. Berg,
Here is your response from yesterday:
Response: Hello, if you could send me the X-ray images with a return envelope, I would evaluate them together with our surgeons in the next quality circle. Copies on the internet are usually not assessable. Best regards, Dr. Berg
Unfortunately, I only have the X-ray images in paper form, maybe there is still something to see on them. Is the fixation with the large one-sided bone gap still tolerable, especially due to the angular misalignment? Are the protruding screw tips hindering or dangerous, could they injure vessels, muscles, and ligaments there?
Thank you in advance.
Hello Mr. Geserer,
The X-rays are exceptionally good and can be assessed very well when enlarged.
Regarding your questions: (based on my assessment and that of my surgeon)
1. The bone gap is not too large, which is absolutely tolerable in a spiral fracture. It is important that the plate is well fixed above and below the main fracture line. The protrusions of the tibia screws are insignificant and common, the cortex, i.e. the outer thicker layer of the long bone, must be securely captured so that the large plate holds. (Screws that are too short and end in the cancellous bone are more dangerous, as they can delay bone healing or cause the plate to break)
2. A angular misalignment? We could not detect any.
3. Now, regarding the long screw in the lower part.
As suspected, this is an adjusting screw for the fibula. This must be fixed as well, as it was also fractured at the top, as seen in image 3. The fact that this screw penetrates the tibia and enters the fibula is not a mistake but intentional. Upon closer examination of the images, it also appears that a small part of the fibula has broken off in a triangular shape, which is fixed by the screw.
Now, I also understand the meaning of the "cross scar": This is an incision that was necessary to guide the screw to fix the fibula at the exact location, or to hold the fibula firmly with a hook so that the screws can be inserted at the desired location.
Whether the tendon was injured during the stabbing incision, or whether the adjusting screw inadvertently caught and damaged the extensor tendon under the skin, can only be clarified through a new operation with anatomical exposure. It could determine whether the tendon is interrupted and possibly attempt reconstruction. If you are considering this, you should do it soon. If this is the case, it would pose a surgical risk (accompanying injuries to tendons and soft tissues) that unfortunately materialized in your case. This risk is listed in the consent form that you surely signed before the operation. Since this cannot be undone, I would recommend a prompt revision.
I hope my assessments were helpful to you.
I wish you all the best. Yours, Dr. R. C. Berg
