Sunday, July 3, 2011

Snowboarder vs. Healing

We just received the radiology report in the mail last night. It was short and to the point.

A comminuted fracture of the distal tibial metaphysis was noted. The fracture extended into the ankle mortise. The fractured segments were in anatomical alignment. Moderate sclerosis was seen around the fractured segments. Some bridging callus formation was noted as well. Multiple old screw tunnels were detected in this area. Moderate narrowing of the anterior and lateral margins of the ankle mortise was seen. Subchondral sclerosis and cystic degenerative changes were seen in this narrowed region of the ankle mortise.

  1. Status post comminuted fracture of the distal tibial metaphysis with evidence for post internal fixation. Anatomical alignment noted.
  2. Incomplete bony union noted.
  3. Moderate apparent traumatic arthritis involving the anterior and lateral margins of the ankle mortise.
What does this all mean? Time to Google it up!

Distal Tibial Metaphysis

Distal is the bottom part of the bone. Tibial is my tibia bone (the big one). And metaphysis is the wider portion of a long bone between the hollow part and the end (the epiphyse). The fracture described in the report starts around the bone graft from my pelvis and extends into the surface of the joint (the mortise).

Incomplete Bony Union

This means my ankle bones are really good at healing. And by really good, I mean terrible.

Subchondral Sclerosis and Cystic Degenerative Changes

Subchondral bone is the layer of bone just below the cartilage. With osteoarthritis, there is increased blood flow and other changes that develop in the subchondral layer -- including subchondral sclerosis, subchondral cyst formation, and increased pressure within the bone -- all of which contribute to osteoarthritis pain.

Subchondral sclerosis is defined as increased bone density or thickening in the subchondral layer. This often occurs with progressive osteoarthritis and shows up on x-rays as abnormally white (dense) bone along the joint line.

Next Steps

Now that I've got my CT scan and report, I will schedule appointments with other orthopedic surgeons in the area. I'm worried that I'm at a higher risk of a failed ankle arthodesis (fusion) because of the multiple non-unions I've already suffered. I suspect all of the non-unions were caused, in part, from the infection I had last year.

We'll keep you all updated!

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