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.

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

Confibulatiom?

Fair.

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.

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.

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.

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.

To be fair to horses, their legs are fingers, which doesn't help the problem.

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.

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.

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.

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.

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

So you wouldn't notice it unless you're a ballerina or something like that?

I saw a guy selling fibulas on the black market and I thought it was humerous. He had that too but it cost an arm and a leg.

When you put something back together and end up with spare parts.

On the internet, nobody knows you are a horse

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.

It's always a great feeling when a doctor looks at something from you and then calls their colleagues to look as well..

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?

You're fine until the Bluetooth disconnects.

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! ^_^

Is it better when it’s a bunch of young doctors?

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.

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.

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.

You'd probably eventually notice just after a long time if you are fairly active, even a loss of rom of a couple degrees adds up over time. You would probably notice a lot faster if you were an athlete, just because the issues would compound faster and you're more connected to your body.

Yeah, it's the only weight bearing compound triplanar joint in the body. So it's a lot more complex than something like the ball and socket joint of your hip. That's why ankle and foot surgeries face a lot more complications and need for revisions compared to most other orthopedic operations.

Fixed Link

I mean there are pretty ruthless horse people, but not many are like that. Everyone I know goes above and beyond for their horses. My mare was considered a lost cause by many when I met her two years ago. I spent those two years rehabbing her and becoming her bestie and now she's in incredible shape physically and mentally. 10/10 worth the effort. I'll probably only get a couple more years with her because she's very old, but she living an exceptionally wonderful life now and that's all that matters to me. I want her to have the best old age she can. She's had a hard life and deserves to live out the rest of her days in comfort and happiness

"Good news, you're about to have a disease named after you!"

Sounds like a minor Fallout 3 villain.

I have a screw box.

I got in on a total ankle replacement once!

I recall the rep referring to the sizers as "lollipop butts" ...and not much else, lol.

My eye doctor did that on one of my recent visits. Apparently my astigmatism is exceptional...

That's a strange thing to call your partner.

I’m fine with that

The students just want to see freaky stuff. E. g. my appendix ruptured when I was 15 and it took my mother a few days to realize I'm not faking. So I have a bunch of scars, some parts are missing and other's just look a bit off. Nothing I don't know or can't live with.

But when they call their fully grown colleagues to look at THAT. That's creepy. That's not good.

I call my box Glory.

"Do you want the good news or the bad news first?"

"The good news"

"We're going to name the disease after you"

The comments on this thread are gold 😂💜

Looks like major leg construction, someone removed it and forgot to put it back in

".... limb lengthening surgery side effect may include missing bones , desire to reverse the surgery,.... death... and other terrible things. Results may vary. No batteries included . No refunds guaranteed. Ask your doctor today."

🌟🌟 Happy Go Lucky music continues to play in the bacckground 👯💃

As a person who has successfully stolen shit from Detroit? I dont think youre correct.

PS : Detroitians. Please lay off the deep dish pizza. AND eat more fibre please!

Skeleton harvester at work

Didn’t think of limb lengthening

Couldn't they just, you know, simulate it on a computer? Or listen to a recording? I guess it's possible you're very old.