Date: Sun, 1 Dec 2002 20:56:19 -0500

Subject: Distal Tibial Bone void

From: Charles M. Blitzer

45 yo women 9 months s/p limited open reduction plus ex-fix high energy pilon. Clinically doing well with minimal pain. Has been walking 6+ weeks with simle air cast (I am chicken to have her with no protection). I originally used Osteoset pellets to graft when I elevated the articular fragments. Now there is a central defect. How big a defect would one tolerate before bone grafting?

Thanks for your thoughts,

Charles Blitzer

Date: Sun, 1 Dec 2002 21:51:21 EST

From: Aobonedoc

I did not download the xrays.

If painless and there was no change in fracture alignment over time, I suppose I would tolerate a large defect.

Sincerely and respectively,

M. Bryan Neal, MD
Arlington Orthopedics and Hand Surgery Specialists, Ltd.
Arlington Heights, Illinois 60005

Date: Sun, 1 Dec 2002 21:50:01 -0600

From: John Early

From what I can see on the flms you sent, that is a large void in the anterior aspect of the tibial metaphysis. I realize that she is assymptomatic now. I would be very worried about a stress fracture occuring in the remaining posterior cortex or worse through the unsupported anterior tibial plafond. I would bone graft her now and allow her to weight bear as tolerated to fill in the defect and protect the reconstructed joint.

John Early MD
Assoc Prof
Univ of TexasSouthwestern Medical Center
Dallas Texas

Date: Mon, 2 Dec 2002 22:38:00 +0500

From: Alexander Chelnokov

Hello Charles,

CMB> with simle air cast (I am chicken to have her with no protection). I originally used Osteoset pellets to graft when I elevated the articularfragments.

It seems to me the current situation requires grafting ASAP.

Best regards,

Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia

Date: Mon, 2 Dec 2002 11:16:50 -0700

From: Thomas A. DeCoster

bone graft.

It looks like there is a wedge shaped (1 cm by 2cm) bone defect of the anterior tibia about 3 cm proximal to the joint with sclerotic margins and the osteocet turned to fibrous tissue rather than bone. I've seen that kind of defect when I've used an osteotome to lever down an impacted anterior articular surface. If the soft tissue allows, that defect should respond well to autologous cancellous grafting with perhaps drilling through the sealing callus.

TD

Date: Mon, 2 Dec 2002 17:13:30 -0600

From: Sciadini, Marcus

I think I would bone graft that defect and consider an anterior plate as well, now that her soft-tissue issues have essentially resolved, presumably. If a low profile locking plate were used, you could also let her continue to weight-bear.

Marcus F. Sciadini