49 year old male who had an open fracture of the left femur in Morocco 20 years previously. Which was treated non-op.
Since then, he's had on/off local drainage and periods of antibiotics
Foul smelling discharge
Dressing changes x5/ day
Requesting amputation (family can't stand the smell)
Non smoker, no co-morbidities, quads adherent limiting knee flexion
32 yrs female, previous PFFD. She had 10cm of lengthening and multiple previous surgeries
Lateral right knee pain
MRI and arthroscopy
Lateral compartment OA, grade-4
Tricompartmental OA changes
Right hip pain (she has OA hip on the same side)
Valgus deformity of the leg
Mild valgus of right tibia
Valgus right ankle with lateral OA changes (secondary to the longstanding valgus leg)
Stiff hindfoot and midfoot
60 y.o. Male, falls from a ladder. Bilateral closed Pilons (this case concerns the right side). Placed into a spanning external fixator and achieved a nice reduction.
The patient got ORIF with plates. The post-op reduction looked decent and no infection. However, at 8-months the medial fixation started to fail. The patient was weight bearing with discomfort, needing crutches and a boot still.
Updated position: The treating surgeons decided to revise the medial fixation and that worked nicely for a while, until the new medial plate/screws broke again! At 29-months the pt was still on crutches and in pain, albeit a little improved (image A). A CT seemed to show that the fracture was healed and so the hardware was taken out (image B). 1-week later, a wt-bearing x-ray clearly showed a varus non-union (image C). See also CTSo, the situation is a varus non-union. Reasonable soft tissues (will tolerate further open surgery). Never been overtly infected.
Please do post your thoughts about these cases in the comments section below.
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