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,