Correction of Post-Traumatic Deformity

• DR. HELFET:
212-606-1888

• DR. LORICH:
212-746-4509

• DR. WEILAND:
212-606-1575

• DR. POSITANO:
212-606-1858

A 49 year-old male sustained a right-sided open mid-shaft tibia fracture after being struck by a stolen pickup truck while riding his bicycle. He was treated at an outside hospital with irrigation and debridement and insertion of an intramedullary (IM) nail. He continued to follow-up at the treating hospital and developed a draining wound near the fracture site and was diagnosed with an MRSA infection and treated by intravenous antibiotics. The intramedullary (IM) nail was eventually removed and several attempts at non-operative management were attempted at the outside hospital and he was told that his infection was eradicated. He came to the NYOTS one year after his injury for a second opinion (his antibiotic treatment had been discontinued 6 months prior). Radiographs were again obtained and revealed a mid-shaft tibial nonunion with significant deformity of approximately 30° varus and 15° flexion. Correction of deformity was planned and performed with debridment of the nonunion site and insertion of a reamed tibial nail with a proximal dynamic interlocking screw. The patient returned for regular follow-up visits and radiographs at 6 months post-operative illustrate a healed tibia nonunion and he reported a return to pre-injury activities and resolution of pain. The IM nail was removed at 1 year following the index surgery.

IMAGES

Figure A Radiographs illustrate a right-sided mid-shaft tibial nonunion with 30° varus deformity and 15° flexion deformity.

Figure B Pre-operative plan for correction of deformity and insertion of a reamed intramedullary (IM) nail.

Figure C Immediate post-operative radiographs following correction of deformity and insertion of a reamed IM nail and screws including a dynamic proximal dynamic interlocking screw.

Figure D Radiographs 1 year following the index surgery illustrate a healed tibia nonunion.

Figure E Fluoroscopic images following removal of the reamed IM nail (13 months following the index surgery).