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It’s always a great feeling when a doctor looks at something from you and then calls their colleagues to look as well…
Is it better when it’s a bunch of young doctors?
I’d say yes. If it’s regular rare it’s interesting for the younglings, if its extra rare it’s interesting even for the experienced.
When you put something back together and end up with spare parts.
One time I was in the ER, and a doctor noted that my heart beat has a rather pronounced split s2 rythm which is something that doctors need to learn to discern when listening to a heartbeat, so for the next hour as I was waiting around, I had several other younger physicians stop by and say “hey I was told to come listen to your heartbeat.”
Made me feel a little special in a very peculiar way I haven’t known since.
A girlfriend’s father had a condition where his organs were mirrored to the opposite side of the body and his circulatory system ran backwards (https://en.wikipedia.org/wiki/Situs_inversus)
Him and his family doctor loved bringing new coworkers in to do a “liver check” or something like that, and watch the person probe around with their hand and slowly get confused, then kind of freak out, when they couldn’t find organs in the body.
They did it for many years and both thought it was hilarious.
I have the same nail in my tibia. I Also fractured my fibula and they said that they don’t normally do much for a fibula break.
The defibrillator strikes again!
Full disclosure: I am not a doctor.
Defibulator 😂
CLEAR
…of fibias!
Um… so looking at the tibia, that is 100% an intramedullary tibial nail:
…which means their tibia was broken as fuck, and there’s a pretty hefty chance the fibula was also broken as fuck in that same injury.
My guess is the missing segment was fragmented to the point of not being saveable, and removed during the same operation the IM nail was placed.
That doesn’t necessarily mean the OP is bullshit - maybe they had some new resident docs, or nurses, or techs or w/e who hadn’t seen that before and it was a genuine wtf moment for them. I love it when new staff get that look!
Is it not a problem to have part of your fibula missing? Can you operate without it?
You’re fine until the Bluetooth disconnects.
It’s not an issue, and pretty easily as it’s not a major weight bearing structure. It mostly functions as an attachment point for various muscles and as A part of the articulation of the ankle joint. Part of it is commonly harvested for use as a bone graft.
The most commonly harvested area starts right at the top of where the missing section begins, so I suspect this post may be bullshit.
I don’t think we’d have lasted long as a species without a little bit of “redundancy”.
I don’t know horses get pretty screwed when they break a leg even with the best medical technology at the owners disposal.
On the internet, nobody knows you are a horse
To be fair to horses, their legs are fingers, which doesn’t help the problem.
I’m imagining sports would be a lot more brutal if once a player got injured, they send out “the vet” onto the field to destroy them if they got any broken fingers or toes.
Is that like non-functional doomed, or like we can’t use them for sport any more so we opt to kill them doomed? I’ve heard the spiel about horses breaking a leg before, but I’m not actually sure what it’s supposed to imply.
It’s doomed as in they’ll die with most bad leg injuries. Horses cant support themselves on 3 legs. They’re just too big. There was a foal with 3 legs that lived for a couple years and made its round on social media, but it was eventually put down because it just grew too large. Poor thing should have been put down immediately because the life it lived was of terrible quality despite getting specialized care.
I’ve seen a few horses get put down for a bad leg injury. Almost had to put down my childhood mare after she fucked up her leg in a fence. She made a full recovery, but it took almost a year for it to heal. Her leg got caught in the wire fence and it got shredded to the bone. It was awful, but she was able to stand on it enough to keep herself upright and all that, so we decided to try to get it healed and were miraculously successful
That’s actually weirdly comforting. I always thought it was a comment on how quick humans are to just dispose of our companions once they start needing care.
And on that note, excellent work for NOT doing that and taking care of your hooved friend! ^_^
Fair.
It basically depends why it’s missing. In general it is not a problem if it is removed after an injury but it can lead to knee problems. However if you have a trauma that warrants a removal you will have very likely knee problems anyway.
If you are missing part of it from birth it is a big problem, because it is usually a sign of Fibular hemimelia and then you will most likely get an amputation
To be clear, othopedics is not my area of expertise,
edit - ortho specialty chimed in. Sounds like it’s responsible for much less than I understood - see the next comment in the chain.
so grain of salt, but to my understanding, it’s basically the radius bone, but of the leg. Aim your toes forward in the normal anatomical position; now rotate your entire foot to the left or right. That’s your fibula working. Without it, very limited rotation; but otherwise you can still walk and function mostly normally, just a bit impaired.I have no idea how ‘chunk missing in the middle’ plays into that. Guessing you’d still have some rotation, but without a secure anchor point, it wouldn’t be great.Aim your toes forward in the normal anatomical position; now rotate your entire foot to the left or right. That’s your fibula working. Without it, very limited rotation; but otherwise you can still walk and function mostly normally, just a bit impaired
Eh… I do specialize in orthopedics and rehabilitation. You can still do all these things without a fully functional fibula, just to a reduced degree. The fibula only contributes to a few degrees of range of motion in the lower limb, we are talking about millimeters. It can be noticeable given enough time or a high enough level of vigorous activity. Most people would live a fairly active lifestyle without noticing this kind of damage to the fibula.
we are talking about millimeters
No shit? I would have guessed at least like 15 degrees of rotation. I think I took the radius comparison a bit too literal.
The radius moves a lot more than the fibula, which makes sense considering the need for moderate rigidity for weight bearing. The fibula only moves around a degree in internal and external rotation and less than a degree in the sagital tilting.
If you think about the rom in the ankle compared to the wrist it makes a bit more sense.
Yeah I wasn’t thinking ankle at all. And even here and now, I’m trying to rotate my own leg while keeping the ankle rigid, and… yea it doesn’t go very far. Never really appreciated just how large a role the ankle plays there.
So you wouldn’t notice it unless you’re a ballerina or something like that?
Muscle contractions and spasms will be indistinguishable between pain or pleasure. Just kidding, it will hellish if you get dehydrated and get muscle spasms. You don’t need it. Source, got a rod myself.
Probably just an atrophic nonunion fracture. If it was that damaged and you were already doing a tibial nail, there wouldn’t really be a reason not to do a fibular nail at the same time.
The fibula has fairly poor blood flow compared to the tibia, it’s not really that rare for the fracture to never callus and bridge back together. If that happens a lot of the times the bone will be subject to resorption.
If it was that damaged and you were already doing a tibial nail, there wouldn’t really be a reason not to do a fibular nail at the same time.
Yeah… supply issue maybe? Or patient opted out due to cost?
/shrug
Supply issues aren’t really an issue, orthopedic operations like this aren’t exactly emergent care. If you have time to procure a tibial nail there isn’t a reason you wouldn’t be able to get a fibular nail at the same time.
As far as cost, the same logic applies. When an orthopedist is coming up with a treatment plan you submit the treatment plan that would best lead to the overall best outcome for the patient, you don’t really formulate based on the most economic outcome.
The insurance company isn’t going to deny a fibular nail, but approve a tibial one. If they are going to go out of pocket, the cost of the fibular nail would be negligible when compared to the overall cost of the operation. The most expensive aspect of an orthopedic moderation is the operating room and the anesthesia, not the additional hardware or operating time.
Just spitballing. Consent issue maybe? Like it only covered tibia, and the staff didn’t notice until the patient was under / couldn’t get a hold of family to have it added?
How quickly can it absorb?
That’s not really how consent works, at least not in the US. You typically give consent for the operation, not for every individual procedure that’s done in the operation. A lot of the times you don’t really know what’s going to be needed to be done until you have the patient opened up, so the provider has a lot of leeway to operate as they see fit.
How quickly can it absorb?
Depends on the individual and what bone we are talking about. Though that’s quite a lot of bone to dissipate, so my guess would be that it’s a fairly old injury.
Can’t have shit in Detroit
It probably was not recoverable when they repaired whatever made that Titanium splint and screws neccesary.
Edit: apparently the middle portion of the fibula is so non-essential for weight-bearing that it is the most common bone harvested for bone grafts elsewhere in the body
Oh so the caption is completely made up
Not necessarily, it could be a group of people who weren’t aware of removing the bone being a thing, but it’s probably a lie for internet points.
Ah, I guess I assumed “everyone” referred to medical professionals involved in the treatment, and that if there was an explanation OOP knew that it would have been included, but I can see how it’s possible
If it makes you feel better, the picture is also old as fuck.
Based on what I read after, given the injury to the Tibia, Mabe the Fibula’s middle was sacrificed for a bone graft, rather than cutting open his good leg as well.
Doesn’t really look like it’s been taken out for a graft, at least not anytime recently. My bet would be he acquired a atrophic nonunion fracture the same time he broke his tibia. The rounded edges of the bone look more like they’ve been subject to resorption instead of being excised.
Honestly not that rare for fibular fractures, though the segment missing is fairly large. So it’s probably a fairly old injury.
I suspect an older harvest. The callus combined with some perimeter resorption tends to lead to a conical profile. Sometimes the callus will even hypertrophy and make a couple of little drumsticks.
It’s a possibility, but I doubt it considering the profile pic seems to be of a relatively young patient. Plus, I’m not seeing anywhere on the tibia where a graft would be necessary, of course it could have been utilized elsewhere.
It would also be an odd place to harvest from, usually you would shoot for an area a little more distal to the attachment point of the extensor hallucis longus.
I hope you got titanium. It’s bio compatible with bone and will fuse together. Took about ten years for me. I was told it’s not important to have a fibula but I think mine probably merged back together since it doesn’t feel like razor blades in my leg.
They didn‘t put everything back after the operation. That’s how I end up with random screws after any repair I do.
[doctor sweeping piece of bone under carpet after surgery]
They try to use it in the next operation. Somebody out there with mismatched bones. One leg longer than the other.
And a paternity test that doesn’t match the mother
Doctors would do no such thing!
…they’d actually just waltz around the hospital with whatever fell onto the OR floor still stuck to their shoe, tracking chunks of it all over the fucking place until some some crusty 70 y/o nurse chews him out while swatting him with today’s word search from the news paper.
Pretty routine stuff, really.
😷🧹🦴📜🤫
Best comment I’ve read on Lemmy today. :D
This is just long enough to make a literal skeleton key
And most of the time those screws aren’t necessary anyway
Tibia surgery affected chronic blood loss to areas of the fibula and thus osteonecrosis of the affected bone. This patient probably has some serious health issues outside their bone health for this to happen.
More than likely just an atrophic nonunion fracture of the fibula. The tibia and fibula were probably broken at the same time, if the fibular fracture looked like it didn’t need to be set they probably didn’t even bother putting hardware in.
You don’t really need to have any serious health issues for this. Sometimes with bones that aren’t weight bearing it’s just bad luck, sometimes it’s because you’re smoking a little too much.
Moopsy!
Just a little sip though in this case.
And even weirder, someone put all these titanium pins in my tibia!
Titanium? In this economy?
Learning the hard way that the titanium nail gun is not a toy
Scientifically speaking, it was probably the fae stealing your bones.
In one of the initial reposts, someone commented there was a complete fracture and the separated part was absorbed naturally over time.
Might have been bs, as it’s known to happen.
