Dr. Henry Urbaniak: A 52-year-old woman fell on an icy step and sustained a closed oblique fracture of the distal part of the right tibia and fibula. Her original x-ray pictures are not available, but they were recorded as showing a "butterfly" type of comminuted tibial fragment. Following an unsuccessful attempt at closed reduction, she was treated by open reduction and internal fixation at another hospital. Initially, a four-hole plate was used, but this did not provide sufficient mobilization, so a Rush rod was used to provide alignment of the major fragments. A circumferential, stainless steel Parham band was added to secure the free butterfly fragment to the remainder of the tibia (Fig 1). Post-operative immobilization was with a long leg cast with the knee flexed about 30°.
The patient's postoperative course was complicated by fever and by severe pain at the operative site. Ten days following her open reduction,
Aufranc OE, Jones WN, Turner RH. Septic Nonunion of Tibial Fracture. JAMA. 1967;200(4):324-327. doi:10.1001/jama.1967.03120170096021