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Message: [QUOTE="MCC, post: 1096824, member: 145"] As this was an open fracture the risk of infection (esp. osteomyelitis) is higher. Osteomyelitis is a bitch to get rid of and pts often require a chest port to deliver IV abx for 4+ months. Also note that there may be damage to surrounding tissues - if anything happens to the peroneal nerve you can end up with drop foot, which means you can't dorsiflex (lift) or evert (turn outward) your foot. The peroneal can reennervate but if it doesn't you end up with a real loss of fine motor control. While you can do a tibial tendon transfer it'll never be quite the same. Severe knee injuries are a more common cause of drop foot (see Jay Williams; his peroneal did reennervate over time) but you can see it with proximal tibial frx. While rare, compartment syndrome can occur after fractures like this; the resulting decrease in blood flow reduces oxygen delivered to nerve and muscle alike - can really complicate the healing process and leave him with less function post recovery. He'd also need another surgery to open up the fascia. Didn't look like a comminuted fracture; appeared to be compound oblique tib fib frx. He'll have a titanium rod (called an intermedullary nail) slotted in his tibia and locking screws placed near the proximal and distal end of the bone. The IM rod will stay in until he's done healing, then it becomes a decoration - most likely it'll be taken back out. Since he's not a multitrauma (e.g. car accident) you'd think he'll heal fine without the need for rBMP-1 (recombinant bone morphogenic protein). In pts who aren't healing well you may need to go to rBMP-1 and an autologous bone graft where you take a few a few chips from the hip area (iliac crest) of the pts pubis. Finally, the fibular frx will likely just be reduced (repositioned into the right alignment) when they do ORIF on the tibial frx - the fib doesn't support much weight and often they don't need to put screws in. The exception is frx near the ankle (malleolar frx) where you can have significant instability. Hard to say where he'll end up 12+ months from now. Any nerve damage, compartment syndrome, or osteomyelitis would really complicate matters and extend his recovery. If he heals "clean" he could certainly play again. [/QUOTE]

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