34-year-old male initially treated for right tibia and fibula fracture with a bilateral intramedullary nail, presented 19 months after the initial operation with acute pain around the fracture site. X-ray examination revealed a healed fibula with a non-union of the distal tibia and a fracture through the nail.
The broken nail was extracted and a new nail inserted and locked distally with 2 locking bolts. The fracture site was decorticated and packed with genex. Closure was achieved with vicryl and a drain was placed over the proximal wound. The patient demonstrated good movement of toes and right ankle. Mobilisation to partial and full weight bearing was recommended as soon as comfortable to do so.
At 3 months’ follow-up the wound was clean and the bone appeared to be healing satisfactorily. The patient had mobilised fully and was extremely pleased with the outcome. At 10 months’ follow-up the non-union had healed completely. The patient had fully recovered and was scheduled to have the intramedullary nail removed.
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