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Forum Name: Bone trauma and fractures

Question: Proximal tibia fracture, non-cortical


 Smislow - Wed Jun 09, 2010 7:53 pm

2 months ago I had a car accident.
Triple open proximal third tibia fracture, with large distal injury with soft tissue damage and m. tibialis anterior tendon rupture.
Ankle of the same leg (left) is fused 10 years ago (arthrodesis talocruralis) with the history of chronic osteomyelitis of the tibial maleolus caused by staph (MSSA).

I was takien immediately to OR, a trauma surgeon fixed tibial fracture with a plate and 12 screws, internaly, and soft tissue repair went well, except a skin defect size about 3x4cm, which was tended later by a plastic surgeon.
All went well, 7 weeks piostoperatively bones were healing well, surgeon alloowed up to 30 kilos weightbear, but I am concerned with slight elevation of body temperature.
In the morning, I tipically have up to 37,1 deg C, in the evenings up to 37.5 deg C.
I performed blood tests and everything is normal, CRP 4.2 and few days later 6.2 mg/L.
After surgery I was put on Warfarin 4,5 mg daily, now INR is 1.66, and I am backing from Warfarin gradually.

There is no sign of infection on the site of trauma, wounds healing good.

What possibly could cause that subfebrile temperature?
 Dr.M.Aroon kamath - Fri Jun 18, 2010 2:45 am

User avatar Hi,
' Normal' body temperature is rather difficult to define (due to conflicting results of many studies). Kindly go through the following link just to get a feel of the complexity of this issue.
http://hypertextbook.com/facts/LenaWong.shtml

Also, one needs to consider other factors such as the route of measurements(oral, axillary or rectal), inter-observer variations etc.

It is true that your recorded temperatures have been too close or overlapping the lower limits of some of the quoted 'normal' ranges. It would be best to go by a combination of
- physical signs & symptoms,
- labs (total WBC count, differential counts, ESR, CRP & blood cultures).

If infection is strongly suspected based on the above, then further investigations such as
- radioisotope bone scan,
- bone biopsy(for culture) &
- CT/MRI
may be needed.
Best wishes!
 Smislow - Sat Jun 19, 2010 2:32 am

Thank You, Dr. Kamath, much obliged.

In the meantime, I observed discomfort in the right lung, which is not a surprise considering my 20 plus years of smoking, last 15yrs 40 cigs a day, and having had a slight pneumonia on the right side twice. My GP couldn't auscultate anything.

Anyhow, my General Practitioner ordered a Complete Blood Count, CRP and urine tests again showing nothing, all normal. Still waiting for lungs x-ray findings, will be the day after tomorrow, on Monday.

My armpit temperature allways was 36.5 deg C normaly, and now is up to 37.6 in the evenings.

Best regards, will keep You posted.

Vedran Galosic,
Croatia

P. S.:
Pardon my occasional misspelling, I learned English mostly speaking it on the job as a Merchant Marine Officer in the nineties.
 Dr.M.Aroon kamath - Fri Jun 25, 2010 12:47 pm

User avatar Hi, quirky997,
Thanks for the update.Never mind the spelling errors.I am glad labs came back normal. Remain under observation till things hopefully get sorted out. Good day!

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