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Tibia and fibula mal-alignment

Am 18 and my leg fracture is now 4 months old, when i initially got the fracture
which is about halfway down the leg, the tibia snapped cleanly in half
and fibular broke too, i was initially put in a cast up to past my
knee, a month later this was removed and another cast applied this one
stopping at the knee, the 'doctor' told me to start attempting to walk
normally thereafter, a month after the cast reduction, it was removed
and i noticed some significant mis-angulation. When i got an x-ray scan
later on, my fears where confirmed, the radiologist said there was '
mal alignment and mis-angulation of the bones. The site of the
fracture protrudes noticeably. on consultation one orthopedic recommended
a brace and the other says the bones will re align. some people have
recommended the option of local medicine mostly massage (am a Ugandan
living in Kampala) any help would be greatly appreciated.
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replied March 8th, 2013
Especially eHealthy
optimus1,

Sorry about your injury.


The following are the usually given acceptable alignments, and when surgery is necessary.

Accetable Reduction:
- more than 50% of cortical overlap;
- > 10 deg of angulation in any plane is unacceptable;
- < 5 deg of varus or valgus;
- < 10 deg of anterior or posterior angulation;
- < 10 deg of rotation;
- < 1 cm for leg length discrepancy;
- no distraction is tolerated;
- 5 mm of distraction may increase healing time to 8-12 months;

Indications for operative correction:
- valgus deformity of more than 10-12 deg;
- varus deformity of more than 6-10 deg;
- external rotation deformity more than 15-20 deg;
- internal rotation deformity of more than 10-15 deg;
- shortening of more than 2 cm


Unfortunately, adults do not have a lot of remodeling potential. So, the use of a brace may work, but, usually not as well as in a small child, who has a lot of growing left to do.

Usually, in adults (which an 18 year old is), the tibia has to be reduced to an close to anatomic as possible. Since an adult has no growth left, there is minimal remodeling of a fracture.


If your malalignment is greater than the values given above, it will usually have to be treated with a surgical osteotomy (cutting the bone and moving it).


Good luck. Hope you are okay.
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