I had RTA and broke my right homers, after Nell’s fracture still moving?

Hi doctors
My names (…) 27 y old intern doctor in TMC Libya
In about 2 months ago I had RTA and broke my right homers > right clavicle and 3 ribs
My doctor did intermediary Nell’s you can see it in the x ray picture
And now 68 day post op and no improvement and the fracture still moving
What’s your opinion ? whats should I do ?
Thank you

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Ahmed Fawzy
1:22 pm

In my opinion bones won t heal unless you fix your renal tubular acidosis by potassium citrate and sodium bicarbonate to fix ph levels , also your x ray show sever osteoprosis , also there is a huge separation between fracture lines , cast is a must after a wire fixation surgery , bones should heal in 3 month cast post wire fixation surgery.
Good Luck

Masr Fawzy
2:29 pm

Surgical fixation with screws and plates will be better in this kinda fracture

Ayman Darrag
4:51 pm

Sorry to tell you that the outcome of this surgery is not good..
In my opinion you need to reoperate by a plate and screws with reduction of bone.. 68 days is long time for callus formation no show …

5:32 am

this fracture is going into non union.
By 1-2 months it should have been united,but at present there are no signs of callus formation.
the nails put inside are inadequate for fixation.
Ideally,intramedullary interlocking should have been done.
Now,the only choice is remove these nails and fix the fracture again with open reduction and fixation with DCP plating with bone graft.