Presentation
Presents after jumping out of a car window.
Patient Data
There is a complete long oblique fracture of the right tibia with a dorsally displaced butterfly fragment. The distal fracture fragment is mildly distally and proximally displaced. There is also a short oblique fracture of the proximal fibula. Soft tissue swelling surrounds the fracture site however no gas is noted. The physes are open and appear normal in contour.
In 1 week, the fracture margins are mildly rounded and smooth periosteal reaction is visible.
After 1 month, the recheck radiographs show exuberant callus formation. The periosteal reaction is mildly irregular surrounding the tibia and fibula. The fragments are moderately well aligned.
At 6 weeks, the fracture is nearly healed with the original butterfly fragment still visible with surrounding lucency. There is smooth bridging callus uniting the tibial and fibular fragments.
Healed fracture, possible sequestrum.
Case Discussion
This fracture had good alignment and conservative treatment was elected. The 6-week timeline illustrates how well young animals can repair fractured bone. The different stages of remodeling show how the tissue responds. In particular, the 3-week radiographs have a more aggressive appearance, and it is important to distinguish rapid healing from an aggressive process such as osteomyelitis. Note how well the tibial and fibular fragments are aligned at the end of the healing process. The remaining bone fragment and surrounding lucency could indicate a sequestrum if the fragment is not vascularized. The patient was doing well and no further followup was performed.
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