On a quarterly basis, William W. Cross III, MD, and Brandon J. Yuan, MD, from Mayo Clinic, Rochester, Minnesota, discuss trauma cases gone wrong in X-ray Forensics. Dr. Cross and Dr. Yuan, who specialize in orthopaedic trauma, provide tips for avoiding mistakes than can compromise patient outcomes.

Current Articles

Symptomatic Malunion of a Displaced Clavicle Fracture
A left comminuted clavicle fracture sustained in a polytrauma accident went on to a symptomatic malunion after a trial of non-operative management. Will thoughtful preoperative planning and operative execution lead to fracture union?
By Brandon J Yuan MD, Krystin A. Hidden MD - Posted 24 Jan 2022

Open Tibia Fracture with an Old Malunion: What to Do?
Definitive fixation of a right open diaphyseal tibia fracture was complicated by a prior fracture of the same tibia sustained nearly 50 years earlier. Using 3D-printed models of the tibia and fibula, the author was able to modify a long proximal tibial locking plate to fit the unique shape of the patient’s tibia.
By Brandon J Yuan MD - Posted 15 Jul 2021

Femoral Shaft Fracture Fixation: It’s All in the Details
The case of an 18-year-old female patient with a closed proximal diaphyseal left femur fracture illustrates how important it is to meticulously follow the principles of intramedullary nailing to achieve a successful outcome.
By Brandon J Yuan MD - Posted 08 Mar 2021

Managing Non-Union of a Periprosthetic Distal Femur Fracture
A decade after successful total knee arthroplasty, a 77-year-old female patient sustains a closed, comminuted supracondylar periprosthetic distal femur fracture in a slip and fall. Following failure of the initial treatment, a revision procedure is needed to achieve bony union.
By Brandon J Yuan MD - Posted 01 Oct 2020

Ankle Fracture Management in a Patient with Diabetes Mellitus
A 72-year-old patient’s fibula fracture has failed to heal 3 months after surgery. Not only that, but a full-thickness skin ulcer has also developed over the medial malleolus. What went wrong, and what should be done during the revision procedure to ensure fracture union?
By Brandon J Yuan, MD - Posted 04 May 2020

Proximal Tibia Non-Union: When an Autograft Does Not Work
A Type IIIC open tibia fracture sustained in a high-speed motor vehicle collision has not progressed toward bony union, despite multiple attempts at treatment. Will a staged approach to management finally lead to fracture union?
By Brandon J Yuan MD - Posted 09 Jan 2020

Repeated Failure of Fixation of an Allograft Humerus Reconstruction
In the 12 years since surgery and chemotherapy for a parosteal osteosarcoma, a young female patient has undergone multiple procedures for non-union at the allograft-host bone junctions in her left humerus. Will a revision fixation procedure finally allow for union of the bone?
By Brandon J Yuan MD - Posted 30 Sep 2019

Fixation Failure in an Atypical Femur Fracture
A 59-year-old female patient presents with a stress fracture at the lateral cortex of the proximal femur. Initial fixation with reconstruction nailing fails, as does revision with a blade plate and autologous bone grafting. Will a second revision procedure allow for union of the fracture?
By Brandon J Yuan MD - Posted 27 Jun 2019

Management of an Acutely Infected Distal Tibial Stress Fracture
A 56-year-old female patient has undergone 2 procedures to treat a stress fracture of the distal tibia and fibula. Five months after the second procedure, she notices increasing varus deformity of the right distal leg, as well as swelling, pain, and fluid collection. What went wrong, and how can this case be successfully resolved?
By Brandon J Yuan MD - Posted 10 Jan 2019

Distal Tibia Non-union After Seemingly Successful Fracture Reduction
A 48-year-old male patient with a closed extra-articular distal tibia and fibula fracture undergoes early definitive fixation with open reduction and internal fixation with locking plates. Although the reduction is anatomic, the fixation failed. What happened, and what could the surgeon have done differently?
By Brandon J Yuan MD - Posted 24 Sep 2018

A Case of Periprosthetic Fracture 15 Years after THA
A 75-year-old patient presents after a fall at home, and she is diagnosed with a Vancouver B1 periprosthetic femur fracture. She had also been diagnosed 3 months earlier with a stress fracture of the left thigh. What is the appropriate treatment for this patient – and why did it fail?
By Brandon J Yuan MD - Posted 16 May 2018

When a Car Met a Motorcycle: Managing a Non-Healing Distal Tibia Fracture
Callus formation still has not occurred 11 weeks after early definitive fixation of 47-year-old patient’s closed intra-articular distal tibia and fibula fracture. Which course of treatment will help prevent an impending non-union of the tibia?
By Brandon J Yuan MD - Posted 21 Dec 2017

Neglected Femoral Neck Fracture and Delayed Union of the Femoral Shaft
Six months after a repair of a closed diaphyseal femur fracture, a 35-year-old patient presents with severe groin pain and the inability to bear weight. What went wrong – and what should be done to fix it?
By Brandon J. Yuan, MD - Posted 20 Sep 2017

3rd Time’s the Charm? Managing a Distal Femoral Non-union
After undergoing 2 failed attempts at repairing her closed metadiaphyseal distal femur fracture, a 60-year-old female patient is scheduled for re-revision surgery. What went wrong with the 2 previous procedures?
By Brandon J Yuan MD - Posted 22 Dec 2016

Failure of a Humerus Shaft Fixation
When non-operative management for a fractured humerus shaft fails, an active 75-year-old farmer agrees to undergo surgery with plate and screw fixation. What goes wrong?
By William W Cross III MD - Posted 30 Aug 2016

The Challenges of Subtrochanteric Fracture Management
In the debut of our new quarterly column X-ray Forensics, orthopaedic trauma specialist Dr. William Cross discusses the challenges with the management of an active male patient who sustained a subtrochanteric fracture of his right hip and how the case was finally resolved.
By William W Cross III MD - Posted 29 Jun 2016