case_images: PMC11823884_01
case_images: Initial injury radiographs of the left ankle including (A) anteroposterior, (B) mortise, and (C) lateral views demonstrating an intraarticular, displaced, comminuted tibial plafond and distal third fibular fracture.
case_images: JOCR-15-11-g001.jpg
case_images: PMC11823884_01_JOCR-15-11-g001.jpg
case_images: F1
case_images: Initial radiographs taken in the ED demonstrated a severely comminuted distal tibial plafond fracture with significant shortening and valgus angulation and an associated transverse distal third fibular shaft fracture (Fig. 1).
case_images: Three month post-operation radiographs of the left ankle including (A) anteroposterior, (B) mortise, and (C) lateral views demonstrating healing of the fibular fracture with minimal healing of the tibial metaphysis despite well-maintained tibial alignment.
case_images: JOCR-15-11-g002.jpg
case_images: PMC11823884_01_JOCR-15-11-g002.jpg
case_images: F2
case_images: Three months post-operation, radiographs demonstrated complete union of the fibula but minimal healing of the tibia, particularly in the metaphyseal region (Fig. 2).
case_images: Four month post-operation pre-ambulation radiographs of the left ankle including (A) anteroposterior and (B) lateral views demonstrating well maintained tibial alignment and intact hardware but minimal further healing of the tibial metaphysis. Four month post-operation post-ambulation radiographs including (C) anteroposterior and (D) lateral views demonstrating acute displacement of the tibial fracture with apex anterior angulation, hardware intact.
case_images: JOCR-15-11-g003.jpg
case_images: PMC11823884_01_JOCR-15-11-g003.jpg
case_images: F3
case_images: Radiographs taken at this visit demonstrated no additional healing of the tibial metaphysis (Fig. 3a and b). Additional radiographs were taken, showing acute worsening of tibial fracture alignment (Fig. 3c and d).
case_images: Six weeks post-revision radiographs of the left ankle including (A) anteroposterior and (B) lateral views demonstrating well-maintained tibial alignment with intact hardware. Autogenous bone graft placed during the revision surgery appears to be maturing. There is some increased bony callus formation over the lateral aspect of the tibia.
case_images: JOCR-15-11-g004.jpg
case_images: PMC11823884_01_JOCR-15-11-g004.jpg
case_images: F4
case_images: Six-week post-revision radiographs demonstrated maintained tibial alignment compared to the immediate post-operative revision imaging and maturation of the bone autograft placed during the revision procedure (Fig. 4).
case_images: Six months post-revision radiographs of the left ankle including (A) anteroposterior and (B) mortise views demonstrating slight increased healing and callus formation relative to prior radiographs. The medial plate demonstrates a proximal and distal screw which have broken.
case_images: JOCR-15-11-g005.jpg
case_images: PMC11823884_01_JOCR-15-11-g005.jpg
case_images: F5
case_images: Imaging from this visit revealed slight increased healing and callus formation relative to prior radiographs, however, two screws had broken in the medial plate (Fig. 5).
case_images: Nine months post-revision radiographs of the left ankle including (A) anteroposterior and (B) mortise views demonstrating further consolidation of the graft site with no further hardware failure.
case_images: JOCR-15-11-g006.jpg
case_images: PMC11823884_01_JOCR-15-11-g006.jpg
case_images: F6
case_images: Repeat imaging demonstrated increased sclerosis and consolidation of the bone graft site, and the orthopedic implant appeared stable without further breakage or loosening (Fig. 6).