PROCEDURES: EXTREMITY LOWER CT WO CONTRAST, 3D RENDERING CT WITH INTERPRETATIONClinical History: Status post ORIF fracture. Followup.CT of right ankle without contrast. Helical multislice CT of the right ankle was performed with multiplanar reconstructions reviewed. Comparison is made with the prior study of 2/25/2010.The plate and screw fixation over the distal fibula is again identified with the fibular fracture demonstrating bridging bone formation in good alignment. The fracture is not completely healed, however, with the posterior and anterior margins demonstrating a cortical gap.In the distal tibia, the comminuted fracture has undergone open reduction and internal fixation with union of some of the smaller fracture fragments and in particular between the anterior and posterior malleolar regions. However, there is continued fracture line visualization in the sagittal, coronal and axial planes consistent with a nonunion. All orthopedic hardware is intact. While the fracture fragments are well aligned, there is significant irregularity of the articular surface at the at the ankle joint with slight asymmetry of the ankle mortise. Approximately 2 to 3 mm of ankle joint articular step-off is noted in its mid section with marginal osteophyte formation anteriorly and early evidence of osteoarthritis in the form of marginal osteophyte formation, joint space narrowing and subchondral sclerosis seen anteriorly.The subtalar joint is unremarkable. Soft tissues image normally.Impression:1. Nonunion of the distal tibial intra-articular comminuted fracture.2. Partial nonunion of the distal fibula fracture3. Degenerative changes at the ankle joint
I have some constructive feedback for Dr. Ramin Abrahim.
First, regarding your comment, "subtalar joint is unremarkable." No, you're subtalar joint is unremarkable. My subtalar joint is awesome, and I'm pretty sure you're jealous of it. If my subtalar joint was on a poster, it'd say, "I'm awesome. Join my fan club on Facebook, won't you?"
What about, "all orthopedic hardware is intact?" Are you serious? In medical school, when you were learning about your job, did they teach you about how you were wrong all the time? There are three broken screws in that hardware. It's easy to tell because one part of the screw is physically not attached to the other part. They are separated by space, thus indicating that they are broken.
Okay, now that I've got that off my chest, I can be calm for a moment. That report doesn't tell me anything that I want to hear, and I respect that. It's honest, and I like that. So it looks like I'm going to have some awesome arthritis. I thought that would happen. It sounds like it's going to hurt. I'm fine with that. I'm sure it's not worse than walking on a broken ankle for six weeks.
I'm still not over the "all orthopedic hardware is intact" comment. Give me a minute.
I'm better now. I don't know what most of the words in that report mean. Let me see if I can define some of them for you.
1. cortical - The outer layer of a bone.2. comminuted - Lots of tiny pieces; mashed potatoes.3. sagittal - A sagittal plane is an imaginary plane that travels vertically from the top to the bottom of the body, dividing it into left and right portions.4. coronal - The plane of section which runs from one side of the body to the other and divides the body into front and back parts.5. All orthopedic hardware is intact - I skipped the Reading CT Scans 101 course in med school not realizing it was fundamental to doing my job well.6. osteophyte - Small abnormal bony outgrowth; responsible for producing demand in the cane market.7. subchondral - Lying under articular cartilage and containing marrow.8. sclerosis - Any pathological hardening or thickening of tissue.9. Subtalar joint is unremarkable - I didn't see anything wrong here, but I just thought I'd tell this patient that this part of his body is lame. Even though he could have gone the rest of his life without knowing about how lame it is.
I visit Dr. Buchanan tomorrow. I'll ask about this report and whether he thinks some of these things can be fixed.