Problem
This case was written by David A. Sandmire, MD and was edited for content for use in this class.
Chief Complaint: 14-year-old girl admitted with a broken left leg.
History: Nicole Michaelson, a 14-year-old girl, was skiing when she fell and broke her left leg. As she fell, her left leg got caught under the body of another skier who ran into her. An X-ray revealed that the fracture was a compound, tibial-fibular fracture just below the knee. The X-ray also revealed a torn meniscal cartilage in the knee above the fracture. The girl remained in the hospital for 14 days because of an infection of the leg in the area of skin breakage. Her immobilized leg was casted after the infection subsided. She remained in a full leg-length cast for 3 months, after which the upper portion of the cast was removed and she was allowed to start bearing weight on the leg. The bones ultimately healed, but the girl continued to have left knee swelling ("water on the knee") and pain made worse by walking. Arthroscopic examination of the knee revealed a meniscus that was still torn 6 months after her injury.
Task
Answer the questions below and submit as a Microsoft Word document or PDF.
A. Ensure you understand what is meant by "tibia-fibular fracture"? What structure connects these two bones and increases the risk of fractures occurring in both leg bones? Where else in the body do you see that kind of structure?
B. What are some possible complications of a compound fracture that would not be as likely with a closed fracture?
C. When comparing the tibia to the fibula, which do you think is most important for Nicole's future mobility (in other words, if you had to pick one of these bones to be so disrupted that it could not be fixed, which would be the most harmful to her future quality of life)? Why?
D. What features of the knee joint structure help minimize friction between the thigh bone and the leg bone? You should name and describe at least three.
E. Why did Nicole's bones heal much more quickly than her cartilage? Specifically speak to the cellular morphology of these two tissues.
F. Propose a possible treatment for the patient in this case study. How does this treatment improve conditions for the patient? Are these improvements seen at the cellular, tissue, organ or systemic level?