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Do I need to undergo surgery for a tibia fracture?

Q: A year ago I fractured my right leg in a severe road accident. It was diagnosed as comminuted fracture of tibia and fibula in which tibia was broken into four pieces. An external fixator was installed, which was removed after 2 months. A plaster was applied and I was advised physiotherapy to help my leg muscles to regrow. The plaster was removed after 3 months and a slight bend was visible in the x-ray. As I began to put more weight on the leg, the bend became more serious and now it is about 15 degrees towards the back of the leg and 5 degrees towards the inside of leg. Some doctors say that I need to undergo a corrective surgery as soon as possible, while others say that the bone will remodel itself over time. Right now I am able to walk upto a kilometre without severe discomfort and there is minimal limping in my walk. Should I go for surgery or wait for the bone to remodel? My job requires a lot of walking along with carrying moderate loads, which I am unable to do right now. Please advise.

A:The tibia is a long bone of the leg, the anterior third of which is just under the skin throughout most of its length. As only a thin layer of skin and subcutaneous tissue with no surrounding muscle covers it, it is vulnerable to injury, which often results in an exposed fracture. Due to its peculiar anatomy, delayed union, nonunion, infection, and osteomyelitis usually aggravate the spontaneous healing of wounds. The reconstruction of partially comminuted fractures or small bone gaps (<6 cm) can usually be done using cancellous or devascularized cortical bone grafting and external fixation while the reconstruction of segmental, comminuted tibial fractures or extensive bone defects (>6 cm) requires vascularized bone grafts to overcome infection and restore bone continuity and blood supply. Usually, the external fixation device is removed after complete bone union is accomplished (generally 10 weeks). Full load-bearing capacity is recovered gradually, and it is recovered completely only after 4-6 months post-surgery. You need to discuss all issues with your treating doctor, their advantages/disadvantages before taking a decision as he is best placed to advise you. It is not possible to comment on an individual case via mail without examining the patient.


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