Bone Grafting - Can any one help me Plz...

[murthy]

Dear Sir,

Thank you for your reply.
I am trying to scan the X-Ray copies to send it to you for your further reference.

However, I am giving you some information about those surgeries by date wise. (Pl find herewith attached word doc. file)

I believe it is too big description and it will kill your precious time..
My request to you is please go through the below info.

Once again I would like to Thank You and I am sorry for taking out your precious time.

Thanks & Regards,
KLN Murthy.

NAME: K.L.N.MURTHY, MALE, 29 YEARS

DATE:31/01/2007

CLINICAL EXAMINATION:-

Laceration wound of size 20 cm.
Extending from medial to lateral side of right knee.
Expand knee joints patella with avulsion of patella tendon.
2 puncture would over the middle 1/3 of right leg.
Lacerated wound extending from base of 2nd toe to the ----- of 5th toe.
Gross abnormal mobility leg at middle 1/3 of right tibia.
posterior tibial artery palpable.

X-RAY CERVICAL SPINE AP AND LATERAL VIEW :-

Cervature of spine lost.
C6 and C7 vertebrae not included in lateral view.
On AP view ? partial fusion C6 and C7 vertebrae laterally on the right (?Block vertebra).
Rest of the vertebral bodies appear normal.
IV disc spaces are normal.
Posterior elements normal.

X-RAY RIGHT ANKLE AP AND LATERAL VIEW:-

Bones are normal in density and alignment.
Epiphyseal centers are normal.
No evidence of osteolytic/sclerotic lesion.
No evidence of bony injury.
Soft tissue planes are maintained,
Evidence of internal fixation noted.

X-RAY RIGHT FOOT AP AND OBLIQUE VIEW:-

Suspicion of subtle cortical lucencies at the base of the 4th, 5th metatarsal bones - ? fracture.
visualized joint spaces are well maintained.
Rest of the soft tissues appears normal.

RIGHT KNEE JOINT AP & LAT VIEW:-

Communated fracture upper third of the right tibia.
Fracture upper third of the right fibula.
Evidence of internal fixation noted.

DETAILS OF SURGERY:-

Under aseptic condition through saline irrigation of wound and debridement done/peroperative.

Findings:- Degloving of skin upper 2/3 right leg anteriorly.
Exposed communited tibia from just below articular surface to mid third tibia.
Vertical fracture patella with communited loose fragments of lateral part of patella.
Avulsed patella tendon.
Exposed right knee joint and patella.
skin defect of upper 2/3 leg right.
Multiple lacerated wounds on foot.

PROCEDURE DONE:-

External fixation of right leg extending from lower thigh to lower third leg.
Schanz pins applied in femur and 5 pins applied in tibia.
All pins connected to rod with clamps.
Irrigation of wound and debridement of necrotic tissue done.
Medial gastrochemices and medial soleus elevated used to cover the defect on 2/3 tibia.
SSG harvested from left thigh and applied over muscle flaps.
Repair of patellar tendon.
Debridement and primary closure of wounds over the foot.

DATE: - 17/04/2007

(AT THE TIME OF 2ND SURGERY

FINAL DIAGNOSIS: - 8 Weeks old Grade III B open fracture both bones
of right leg.

CHIEF COMPLAINTS:- Admitted for tubular external fixation and Ilizarov ring fixation application and skin grafting.

Local Examination:-

Bi planar tubular external fixation in situ.
Old healed scar of flap present.
Gap palpable over the fracture site.
Movement at ankle restricted.


DATE: - 26/07/07

DETAILS OF SURGERY:-

Under aseptic condions, Under spinal Anesthesia, In supine position,
Ilizarov's pin and rings were removed.
New Ilizarov's wires are inserted according to pre planned ring adjustments.
2 rings proximal to fracture site.
2 rings distal to fracture site.
Wires fixed to rings and tensioning done.
Bone graft taken from left Iliac crest and grafting done along with medial aspect of the fracture site.
Fracture site fibrous tissue not disturbed.
Wound closed in layers.
After securing hemostasis, ASD done.

[murthy]

Hi Mr. Physiobob,

Pl find herewith attached some X-Ray copies by date wise for your reference.

Thanks & Regards,
KLN Murthy.

[murthy]

Sir,

Did you find my post??

Regards/KLN Murthy.

[physiobob]

Wow!!! You certainly did a good job. I see from the xrays that these coder two periods, the most recent being in Dec 2007. Perhaps that was after the second grafting.

To be honest I think the surgeons have done a poor job, or that the fixation is not holding. There seems to have been movement in the bones since the earlier images and the alignment is way off. Not sure how one wants to get bone union when the bones are not in a placement to encourage them joining together.

I am sorry to be so blunt and negative but if I were in your shoes I would be looking for another orthopaedic opinion asap. Have you any facility to seek treatment in another country?