Comment on “Tf???”
Murse@slrpnk.net 10 hours ago
Um… so looking at the tibia, that is 100% an intramedullary tibial nail:
…which means their tibia was broken as fuck, and there’s a pretty hefty chance the fibula was also broken as fuck in that same injury.
My guess is the missing segment was fragmented to the point of not being saveable, and removed during the same operation the IM nail was placed.
That doesn’t necessarily mean the OP is bullshit - maybe they had some new resident docs, or nurses, or techs or w/e who hadn’t seen that before and it was a genuine wtf moment for them. I love it when new staff get that look!
Probably just an atrophic nonunion fracture. If it was that damaged and you were already doing a tibial nail, there wouldn’t really be a reason not to do a fibular nail at the same time.
The fibula has fairly poor blood flow compared to the tibia, it’s not really that rare for the fracture to never callus and bridge back together. If that happens a lot of the times the bone will be subject to resorption.
If it was that damaged and you were already doing a tibial nail, there wouldn’t really be a reason not to do a fibular nail at the same time.
Yeah… supply issue maybe? Or patient opted out due to cost?
/shrug
Supply issues aren’t really an issue, orthopedic operations like this aren’t exactly emergent care. If you have time to procure a tibial nail there isn’t a reason you wouldn’t be able to get a fibular nail at the same time.
As far as cost, the same logic applies. When an orthopedist is coming up with a treatment plan you submit the treatment plan that would best lead to the overall best outcome for the patient, you don’t really formulate based on the most economic outcome.
The insurance company isn’t going to deny a fibular nail, but approve a tibial one. If they are going to go out of pocket, the cost of the fibular nail would be negligible when compared to the overall cost of the operation. The most expensive aspect of an orthopedic moderation is the operating room and the anesthesia, not the additional hardware or operating time.
naught101@lemmy.world 9 hours ago
Is it not a problem to have part of your fibula missing? Can you operate without it?
SoleInvictus@lemmy.blahaj.zone 7 hours ago
It’s not an issue, and pretty easily as it’s not a major weight bearing structure. It mostly functions as an attachment point for various muscles and as A part of the articulation of the ankle joint. Part of it is commonly harvested for use as a bone graft.
The most commonly harvested area, approximately the center third, starts right at the top of where the missing section begins, so I suspect this post is pure bullshit.
Murse@slrpnk.net 7 hours ago
To be clear, othopedics is not my area of expertise, so grain of salt, but to my understanding, it’s basically the radius bone, but of the leg. Aim your toes forward in the normal anatomical position; now rotate your entire foot to the left or right. That’s your fibula working. Without it, very limited rotation; but otherwise you can still walk and function mostly normally, just a bit impaired.
I have no idea how ‘chunk missing in the middle’ plays into that. Guessing you’d still have some rotation, but without a secure anchor point, it wouldn’t be great.
TranscendentalEmpire@lemmy.today 6 hours ago
Eh… I do specialize in orthopedics and rehabilitation. You can still do all these things without a fully functional fibula, just to a reduced degree. The fibula only contributes to a few degrees of range of motion in the lower limb, we are talking about millimeters. It can be noticeable given enough time or a high enough level of vigorous activity. Most people would live a fairly active lifestyle without noticing this kind of damage to the fibula.
Murse@slrpnk.net 6 hours ago
No shit? I would have guessed at least like 15 degrees of rotation. I think I took the radius comparison a bit too literal.
drosophila@lemmy.blahaj.zone 5 hours ago
So you won’t notice it unless you’re a ballerina or something?
myyass@lemmy.world 8 hours ago
Muscle contractions and spasms will be indistinguishable between pain or pleasure. Just kidding, it will hellish if you get dehydrated and get muscle spasms. You don’t need it. Source, got a rod myself.