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!
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’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
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.
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.
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.
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?
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?
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
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.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.
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.
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?