16/05/2026
This was a really nasty fracture! 😬
Highly comminuted, highly unstable (the tibia felt like a bag of marbles) and grade I open (and probably for some time). Major concerns were:
1. High energy injury – there will have been massive soft tissue disruption along with the visible bony injury, meaning vascularity was a big concern and delayed healing anticipated
2. Delayed healing means the stabilisation system was going to need to be sufficiently robust to avoid implant failure before union could occur
3. Infection risk, and possible need to remove implants at a later date
Surgical strategy after patient stabilisation:
1. Virtual fracture ‘reconstruction’ in to plan implant selection
2. Temporary IM pin and ESF to maintain limb alignment in surgery
3. Intraoperative radiography to assess limb alignment and guide implant placement
4. Minimally-invasive plate osteosynthesis (MIPO) to minimise further disruption of the soft tissues/vascular supply at the fracture site, using precontoured cranial and medial plates
5. Double locking plate fixation to provide robust bridging of the fracture and to allow 4 screws to be placed in the very small proximal fragment
Milly has been a 💫 patient and has been using the limb fantastically well from soon after surgery. Predictably her fracture took longer than most fractures to heal but by 5 months, with the help of oblique views, we could be confident there was bridging bone along the length of the tibia and she was returned to full activity. Video below 👇. There have been no infections 🙂
Big thanks to for referring Millie and to her owners for allowing us to save her leg and for being so diligent with her aftercare 🙏🙏🙏
